AIMS To investigate the incremental prognostic value of morphological plaque features beyond clinical risk and coronary stenosis levels. Although associated with the degree of coronary stenosis, most cardiac events occur on the basis of ruptured non-obstructive plaques and consecutive vessel thrombosis. As such, identification of vulnerable plaques is paramount for cardiovascular risk prediction and treatment decisions. METHODS AND RESULTS A total of 1615 patients with suspected but not previously diagnosed coronary artery disease (CAD) were examined by coronary computed tomography angiography and morphological plaque features were assessed. Mean follow-up was 10.5 (interquartile range 9.2-11.4) years. Cox proportional hazards analysis was used for the composite endpoint of cardiac death and non-fatal myocardial infarction. The study endpoint was reached in 51 patients (36 cardiac deaths, 15 non-fatal myocardial infarctions). In addition to quantitative parameters (presence of any calcified/non-calcified plaque or elevated plaque load), morphologic plaque features such as a spotty or gross calcification pattern and napkin-ring sign (NRS) were predictive for events. However, only spotty calcified plaques and NRS could confer additive prognostic value beyond clinical risk and coronary stenosis level. In a stepwise approach, endpoint prediction beyond clinical risk (Morise score) could be improved by inclusion of CAD severity (χ2 of 27.5, P < 0.001) and further discrimination for spotty calcified plaques (χ2 of 3.89, P = 0.049). CONCLUSION Improved cardiovascular risk prediction beyond clinical risk and coronary stenosis levels can be made by discriminating for the presence of spotty calcified plaques. Thus, an intensified prophylactic anti-atherosclerotic treatment appears to be warranted in patients with coronary plaques that show spotty calcifications.

中文翻译：

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形态斑块特征对冠状动脉计算机断层扫描血管造影的长期预后价值。

目的探讨形态斑块特征在临床风险和冠状动脉狭窄水平之外的增加的预后价值。尽管与冠状动脉狭窄程度有关，但大多数心脏事件是基于破裂性非阻塞性斑块和连续的血管血栓形成而发生的。因此，对易损斑块的识别对于心血管风险预测和治疗决策至关重要。方法和结果通过冠状动脉计算机断层造影血管造影检查了总共1615例可疑但先前未诊断为冠心病（CAD）的患者，并对形态斑块特征进行了评估。平均随访时间为10.5年（四分位间距9.2-11.4）年。Cox比例风险分析用于心源性死亡和非致命性心肌梗死的复合终点。51例患者达到了研究终点（36例心脏死亡，15例非致命性心肌梗塞）。除了定量参数（存在任何钙化/非钙化斑块或升高的斑块负荷）之外，形态斑块特征（例如斑点或大块钙化模式和餐巾环征（NRS））也可预测事件。但是，只有斑点钙化斑块和NRS才能赋予附加的预后价值，超过临床风险和冠状动脉狭窄水平。采用逐步方法，可以通过纳入CAD严重程度（χ2为27.5，P <0.001）并进一步区分斑点钙化斑块（χ2为3.89，P = 0.049）来改善超出临床风险（Morise评分）的终点预测。结论通过区分斑点钙化斑块的存在，可以改善心血管风险的预测，使其超过临床风险和冠状动脉狭窄水平。因此，对于显示斑点钙化的冠状动脉斑块的患者，似乎有必要加强预防性的抗动脉粥样硬化治疗。