Coronary Artery Plaque Characteristics Associated With Adverse Outcomes in the SCOT-HEART Study

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:73

Article

Williams, Michelle C.^1,2  Moss, Alastair J.¹  Dweck, Marc^1,2  Adamson, Philip D.^1,3  Alam, Shirjel¹  Hunter, Amanda¹  Shah, Anoop S., V¹  Pawade, Tania¹  Weir-McCall, Jonathan R.⁴  Roditi, Giles⁵  van Beek, Win J. R.²  Newby, David E.^1,2  Nicol, Edward D.^6,7,8 

[1] Univ Edinburgh, British Heart Fdn Ctr Cardiovasc Sci, Chancellors Bldg,SU305,49 Little France Crescent, Edinburgh EH1 6SUF, Midlothian, Scotland

[2] Univ Edinburgh, Edinburgh Imaging Facil QMRI, Edinburgh, Midlothian, Scotland

[3] Univ Otago, Christchurch Heart Inst, Christchurch, New Zealand

[4] Univ Cambridge, Sch Clin Med, Biomed Res Ctr, Cambridge, England

[5] Univ Glasgow, Inst Clin Sci, Glasgow, Lanark, Scotland

[6] Royal Brompton & Harefield NHS Fdn Trust, Dept Cardiol, London, England

[7] Royal Brompton & Harefield NHS Fdn Trust, Dept Radiol, London, England

[8] Imperial Coll, Fac Med, Natl Heart & Lung Inst, London, England

关键词: atherosclerotic plaque;    computed tomography;    coronary angiography;    coronary artery disease;   

DOI  :  10.1016/j.jacc.2018.10.066

来源: Elsevier

【 摘 要 】

BACKGROUND Unlike most noninvasive imaging modalities, coronary computed tomography angiography can characterize subtypes of atherosclerotic plaque. OBJECTIVES The purpose of this study was to investigate the prognostic implications of adverse coronary plaque characteristics in patients with suspected coronary artery disease. METHODS In this SCOT-HEART (Scottish COmputed Tomography of the HEART Trial) post hoc analysis, the presence of adverse plaque (positive remodeling or low attenuation plaque), obstructive disease, and coronary artery calcification within 15 coronary segments was assessed on coronary computed tomography angiography of 1,769 patients who were followed-up for 5 years. RESULTS Among study participants (mean age 58 +/- 10 years; 56% male), 608 (34%) patients had 1 or more adverse plaque features. Coronary heart disease death or nonfatal myocardial infarction was 3 times more frequent in patients with adverse plaque (n = 25 of 608 [4.1%] vs. n = 16 of 1,161 [1.4%]; p < 0.001; hazard ratio [HR]: 3.01; 95% confidence interval (CI): 1.61 to 5.63; p = 0.001) and was twice as frequent in those with obstructive disease (n = 22 of 452 [4.9%] vs. n = 16 of 671 [2.4%]; p = 0.024; HR: 1.99; 95% CI: 1.05 to 3.79; p = 0.036). Patients with both obstructive disease and adverse plaque had the highest event rate, with a 10-fold increase in coronary heart disease death or nonfatal myocardial infarction compared with patients with normal coronary arteries (HR: 11.50; 95% CI: 3.39 to 39.04; p < 0.001). However, these associations were not independent of coronary artery calcium score, a surrogate measure of coronary plaque burden. CONCLUSIONS Adverse coronary plaque characteristics and overall calcified plaque burden confer an increased risk of coronary heart disease death or nonfatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590) (c) 2019 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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