Atherosclerosis quantification and cardiovascular risk: the ISCHEMIA trial.

Autor:	Nurmohamed NS; Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.; Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.; Division of Cardiology, The George Washington University School of Medicine, 2150 Pennsylvania Avenue NW, Washington, DC 20037, USA., Min JK; Cleerly, Inc, Denver, CO, USA., Anthopolos R; New York University Grossman School of Medicine, New York, NY, USA., Reynolds HR; New York University Grossman School of Medicine, New York, NY, USA., Earls JP; Cleerly, Inc, Denver, CO, USA.; Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA., Crabtree T; Cleerly, Inc, Denver, CO, USA., Mancini GBJ; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada., Leipsic J; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada., Budoff MJ; Lundquist Institute, Torrance, CA, USA., Hague CJ; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada., O'Brien SM; Duke Clinical Research Institute, Durham, NC, USA., Stone GW; Icahn School of Medicine at Mount Sinai, New York, NY, USA., Berger JS; New York University Grossman School of Medicine, New York, NY, USA., Donnino R; New York University Grossman School of Medicine, New York, NY, USA., Sidhu MS; Albany Medical College, Albany, NY, USA., Newman JD; New York University Grossman School of Medicine, New York, NY, USA., Boden WE; VA New England Healthcare System, Boston University School of Medicine, Boston, MA, USA., Chaitman BR; St Louis University School of Medicine Center for Comprehensive Cardiovascular Care, St Louis, MO, USA., Stone PH; Brigham and Women's Hospital, Boston, MA, USA., Bangalore S; New York University Grossman School of Medicine, New York, NY, USA., Spertus JA; University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, MO, USA., Mark DB; Duke Clinical Research Institute, Durham, NC, USA., Shaw LJ; Bronfman Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY, USA., Hochman JS; New York University Grossman School of Medicine, New York, NY, USA., Maron DJ; Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2024 Sep 29; Vol. 45 (36), pp. 3735-3747.
DOI:	10.1093/eurheartj/ehae471
Abstrakt:	Background and Aims: The aim of this study was to determine the prognostic value of coronary computed tomography angiography (CCTA)-derived atherosclerotic plaque analysis in ISCHEMIA. Methods: Atherosclerosis imaging quantitative computed tomography (AI-QCT) was performed on all available baseline CCTAs to quantify plaque volume, composition, and distribution. Multivariable Cox regression was used to examine the association between baseline risk factors (age, sex, smoking, diabetes, hypertension, ejection fraction, prior coronary disease, estimated glomerular filtration rate, and statin use), number of diseased vessels, atherosclerotic plaque characteristics determined by AI-QCT, and a composite primary outcome of cardiovascular death or myocardial infarction over a median follow-up of 3.3 (interquartile range 2.2-4.4) years. The predictive value of plaque quantification over risk factors was compared in an area under the curve (AUC) analysis. Results: Analysable CCTA data were available from 3711 participants (mean age 64 years, 21% female, 79% multivessel coronary artery disease). Amongst the AI-QCT variables, total plaque volume was most strongly associated with the primary outcome (adjusted hazard ratio 1.56, 95% confidence interval 1.25-1.97 per interquartile range increase [559 mm3]; P = .001). The addition of AI-QCT plaque quantification and characterization to baseline risk factors improved the model's predictive value for the primary outcome at 6 months (AUC 0.688 vs. 0.637; P = .006), at 2 years (AUC 0.660 vs. 0.617; P = .003), and at 4 years of follow-up (AUC 0.654 vs. 0.608; P = .002). The findings were similar for the other reported outcomes. Conclusions: In ISCHEMIA, total plaque volume was associated with cardiovascular death or myocardial infarction. In this highly diseased, high-risk population, enhanced assessment of atherosclerotic burden using AI-QCT-derived measures of plaque volume and composition modestly improved event prediction. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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