Background and aims

Cardiac computed tomographic angiography (CCTA) - derived measures of coronary artery disease (CAD) burden have been shown to independently predict incident cardiovascular events. We aimed to compare the added prognostic value of plaque burden to CCTA anatomic assessment and single photon emission computed tomography (SPECT) physiologic assessment in a cohort with high prevalence of risk factors undergoing both tests.

Methods

Consecutive patients who underwent clinically indicated CCTA and SPECT myocardial imaging for suspected CAD were included. Stenosis severity and segment involvement score (SIS - number of segments with plaque irrespective of stenosis) were determined from CCTA, and presence of ischemia was determined from SPECT. Patients were followed for major adverse cardiovascular events (MACE, inclusive of all-cause death, non-fatal myocardial infarction, and percutaneous coronary intervention or coronary artery bypass grafting 90-days after imaging test.)

Results

A total of 956 patients were included (mean age 61.1 ± 14.2 years, 54% men, 89% hypertension, 81% diabetes, 84% dyslipidemia). Obstructive stenosis (left main ≥50%, all other coronary segments ≥70%) and ischemia were observed in a similar number of patients (14%). In multivariable Cox regression models, SIS significantly predicted outcomes and improved risk discrimination in models with CCTA obstructive stenosis (HR 1.15, p ≤ 0.001; Harrel's C 0.74, p = 0.008) and SPECT ischemia (HR 1.14, p < 0.001; Harrel's C 0.76, p = 0.019).

Conclusions

Our results suggest that in patients with suspected CAD and a high prevalence of risk-factors, plaque burden adds incremental prognostic value over established CCTA and SPECT measures to predict incident cardiovascular outcomes.

中文翻译：

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增加斑块负荷对计算机断层扫描血管造影和心肌灌注成像的预后价值

背景和目标

心脏计算机断层扫描血管造影 (CCTA) - 冠状动脉疾病 (CAD) 负担的衍生测量已被证明可以独立预测心血管事件。我们旨在比较斑块负荷对 CCTA 解剖学评估和单光子发射计算机断层扫描 (SPECT) 生理学评估的附加预后价值，该队列具有接受两种测试的高风险因素流行率。

方法

连续接受了临床指征的 CCTA 和 SPECT 心肌成像以怀疑 CAD 的患者被包括在内。狭窄严重程度和节段受累评分（SIS - 与狭窄无关的斑块节段数）由 CCTA 确定，缺血的存在由 SPECT 确定。随访患者的主要不良心血管事件（MACE，包括全因死亡、非致死性心肌梗死和影像学检查后 90 天的经皮冠状动脉介入治疗或冠状动脉旁路移植术）。

结果

总共包括 956 名患者（平均年龄 61.1 ± 14.2 岁，54% 男性，89% 高血压，81% 糖尿病，84% 血脂异常）。在相似数量的患者 (14%) 中观察到阻塞性狭窄（左主干≥50%，所有其他冠状动脉节段≥70%）和缺血。在多变量 Cox 回归模型中，SIS 显着预测了 CCTA 阻塞性狭窄（HR 1.15，p ≤ 0.001；Harrel's C 0.74，p  = 0.008）和 SPECT 缺血（HR 1.14，p < 0.001；Harrel's C 0.0. , p  = 0.019)。

结论

我们的研究结果表明，在疑似 CAD 和危险因素高发的患者中，斑块负荷比已建立的 CCTA 和 SPECT 措施增加了增加的预后价值，以预测心血管事件的结局。