BackgroundProgression of coronary artery disease using serial coronary computed tomography angiography (CTA) is of clinical interest. Our primary aim was to prospectively assess the impact of clinical characteristics and statin use on quantitatively assessed coronary plaque progression in a low-risk study population during long-term follow-up.MethodsPatients who previously underwent coronary CTA for suspected coronary artery disease were prospectively included to undergo follow-up coronary CTA. The primary end point was coronary artery disease progression, defined as the absolute annual increase in total, calcified, and noncalcified plaque volume by quantitative CTA analysis.ResultsIn total, 202 patients underwent serial coronary CTA with a mean interscan period of 6.2±1.4 years. On a per-plaque basis, increasing age (β=0.070; P=0.058) and hypertension (β=1.380; P=0.075) were nonsignificantly associated with annual total plaque progression. Male sex (β=1.676; P=0.009), diabetes mellitus (β=1.725; P=0.012), and statin use (β=1.498; P=0.046) showed an independent association with annual progression of calcified plaque. While hypertension (β=2.259; P=0.015) was an independent determinant of noncalcified plaque progression, statin use (β=−2.178; P=0.050) was borderline significantly associated with a reduced progression of noncalcified plaque.ConclusionsStatin use was associated with an increased progression of calcified coronary plaque and a reduced progression of noncalcified coronary plaque, potentially reflecting calcification of the noncalcified plaque component. Whereas hypertension was the only modifiable risk factor predictive of noncalcified plaque progression, diabetes mellitus mainly led to an increase in calcified plaque. These findings could yield the need for intensified preventive treatment of patients with diabetes mellitus and hypertension to slow and stabilize coronary artery disease progression and improve clinical outcome.

中文翻译：

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临床特征和他汀类药物对系列计算机断层扫描血管造影对冠状动脉斑块进展的影响。

背景技术使用系列冠状动脉计算机断层摄影血管造影术（CTA）进行冠状动脉疾病的进展具有临床意义。我们的主要目的是前瞻性评估长期随访中低风险研究人群的临床特征和他汀类药物使用对定量评估冠状动脉斑块进展的影响。方法前瞻性纳入先前因怀疑冠心病而接受冠状动脉CTA的患者进行冠状动脉CTA随访。主要终点是冠状动脉疾病的进展，通过定量CTA分析定义为总的，钙化的和非钙化的斑块量的绝对年度增加。结果总共202例患者接受了连续冠状动脉CTA，平均扫描间期为6.2±1.4年。以每斑为基础，年龄增长（β= 0.070；P = 0.058）和高血压（β= 1.380; P = 0.075）与年度总斑块进展无显着相关性。男性（β= 1.676; P = 0.009），糖尿病（β= 1.725; P = 0.012）和他汀类药物的使用（β= 1.498; P = 0.046）与钙化斑块的年进展独立相关。高血压（β= 2.259; P = 0.015）是非钙化斑块进展的独立决定因素，而他汀类药物的使用（β= -2.178; P= 0.050）与未钙化斑块进展减少显着相关。结论他汀类药物的使用与钙化冠状斑块进展增加和未钙化冠状斑块进展减少相关，可能反映了未钙化斑块成分的钙化。高血压是预测非钙化斑块发展的唯一可改变的危险因素，而糖尿病主要导致钙化斑块的增加。这些发现可能需要加强对糖尿病和高血压患者的预防性治疗，以减缓和稳定冠状动脉疾病的进展并改善临床结局。