Plaque Burden and 1-Year Outcomes in Acute Chest Pain,JACC: Cardiovascular Imaging

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Plaque Burden and 1-Year Outcomes in Acute Chest Pain
JACC: Cardiovascular Imaging ( IF 12.8 ) Pub Date : 2022-06-15 , DOI: 10.1016/j.jcmg.2022.04.024
Mohammed N Meah ₁ , Evangelos Tzolos ₁ , Kang-Ling Wang ₁ , Anda Bularga ₁ , Marc R Dweck ₁ , Nick Curzen ₂ , Attila Kardos ₃ , Liza Keating ₄ , Robert F Storey ₅ , Nicholas L Mills ₆ , Piotr J Slomka ₇ , Damini Dey ₇ , David E Newby ₈ , Alasdair Gray ₆ , Michelle C Williams ₈ , Carl Roobottom ₉

Affiliation

BHF Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
Faculty of Medicine, University of Southampton, Southampton, United Kingdom; University Hospital Southampton, Southampton, United Kingdom.
Department of Cardiology Milton Keynes University Hospital, School of Sciences and Medicine, University of Buckingham, Buckingham, United Kingdom.
Royal Berkshire NHS Foundation Trust, Reading, United Kingdom.
University of Sheffield, Sheffield, United Kingdom.
BHF Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.
BHF Centre of Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, United Kingdom.
University Hospital Plymouth, Plymouth, United Kingdom.

Background

In patients with stable chest pain, computed tomography (CT) plaque burden is an independent predictor of future coronary events.

Objectives

The purpose of this study was to determine whether plaque burden and characteristics can predict subsequent death or myocardial infarction in patients with acute chest pain.

Methods

In a post hoc analysis of a multicenter trial of early coronary CT angiography, the authors performed quantitative plaque analysis to assess the association between primary endpoint of 1-year all-cause death or nonfatal myocardial infarction and the GRACE (Global Registry of Acute Coronary Events) score, presence of obstructive coronary artery disease, and plaque burden in 404 patients with suspected acute coronary syndrome.

Results

Following the index event, 25 patients had a primary event that was associated with a higher GRACE score (134 ± 44 vs 113 ± 35; P = 0.012), larger burdens of total (46% [IQR: 43%-50%] vs 36% [IQR: 21%-46%]; P < 0.001), noncalcified (41% [IQR: 37%-%47] vs 33% [IQR: 20%-41%]; P < 0.001), and low-attenuation plaque (4.22% [IQR: 3.3%-5.68%] vs 2.14% [IQR: 0.5%-4.88%]; P < 0.001), but not obstructive coronary artery disease (P = 0.065). Total, noncalcified, and low-attenuation plaque burden were the strongest predictors of future events independent of GRACE score and obstructive coronary artery disease (P ≤ 0.002 for all). Patients with a low-attenuation burden above the median had nearly an 8-fold increased risk of the primary endpoint (HR: 7.80 [95% CI: 2.33-26.0]; P < 0.001), outperforming either a GRACE score of >140 (HR: 3.80 [95% CI :1.45-6.98]; P = 0.004) or obstructive coronary artery disease (HR: 2.07 [95% CI: 0.94-4.53]; P = 0.07).

Conclusions

In patients with suspected acute coronary syndrome, low-attenuation plaque burden is a major predictor of 1-year death or recurrent myocardial infarction. (Rapid Assessment of Potential Ischaemic Heart Disease With CTCA [RAPID-CTCA]; NCT02284191)

中文翻译：

急性胸痛的斑块负担和一年结果

背景

对于稳定胸痛的患者，计算机断层扫描 (CT) 斑块负荷是未来冠状动脉事件的独立预测因素。

目标

本研究的目的是确定斑块负荷和特征是否可以预测急性胸痛患者随后的死亡或心肌梗死。

方法

在一项早期冠状动脉 CT 血管造影多中心试验的事后分析中，作者进行了定量斑块分析，以评估 1 年全因死亡或非致命性心肌梗死的主要终点与 GRACE（全球急性冠状动脉事件登记）之间的关联) 404 名疑似急性冠状动脉综合征患者的评分、是否存在阻塞性冠状动脉疾病以及斑块负荷。

结果

在指数事件之后，25 名患者发生了与较高 GRACE 评分相关的主要事件（134 ± 44 vs 113 ± 35；P = 0.012），总负担较大（46% [IQR: 43%-50%] vs 36% [IQR: 21%-46%]；P < 0.001)，非钙化（41% [IQR: 37%-%47] vs 33% [IQR: 20%-41%]；P < 0.001），低- 斑块衰减（4.22% [IQR：3.3%-5.68%] vs 2.14% [IQR：0.5%-4.88%]；P < 0.001），但不是阻塞性冠状动脉疾病（P = 0.065）。总斑块负荷、非钙化斑块负荷和低衰减斑块负荷是未来事件的最强预测因子，与 GRACE 评分和阻塞性冠状动脉疾病无关（所有P ≤ 0.002）。低衰减负担高于中位数的患者的主要终点风险增加了近 8 倍（HR：7.80 [95% CI：2.33-26.0]；P < 0.001），优于 GRACE 评分 >140 的患者（ HR：3.80 [95% CI：1.45-6.98]；P = 0.004）或阻塞性冠状动脉疾病（HR：2.07 [95% CI：0.94-4.53]；P = 0.07）。