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Coronary Atherosclerotic Precursors of Acute Coronary Syndromes

Title
Coronary Atherosclerotic Precursors of Acute Coronary Syndromes
Author
허란
Keywords
acute coronary syndrome; atherosclerosis; clinical outcome; coronary artery disease; coronary computed tomography angiography
Issue Date
2018-06
Publisher
ELSEVIER SCIENCE INC
Citation
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, v. 71, no. 22, page. 2511-2522
Abstract
BACKGROUND The association of atherosclerotic features with first acute coronary syndromes (ACS) has not accounted for plaque burden.OBJECTIVES The purpose of this study was to identify atherosclerotic features associated with precursors of ACS.METHODS We performed a nested case-control study within a cohort of 25,251 patients undergoing coronary computed tomographic angiography (CTA) with follow-up over 3.4 +/- 2.1 years. Patients with ACS and nonevent patients with no prior coronary artery disease (CAD) were propensity matched 1:1 for risk factors and coronary CTA-evaluated obstructive (>= 50%) CAD. Separate core laboratories performed blinded adjudication of ACS and culprit lesions and quantification of baseline coronary CTA for percent diameter stenosis (%DS), percent cross-sectional plaque burden (PB), plaque volumes (PVs) by composition (calcified, fibrous, fibrofatty, and necrotic core), and presence of high-risk plaques (HRPs).RESULTS We identified 234 ACS and control pairs (age 62 years, 63% male). More than 65% of patients with ACS had nonobstructive CAD at baseline, and 52% had HRP. The %DS, cross-sectional PB, fibrofatty and necrotic core volume, and HRP increased the adjusted hazard ratio (HR) of ACS (1.010 per %DS, 95% confidence interval [CI]: 1.005 to 1.015; 1.008 per percent cross-sectional PB, 95% CI: 1.003 to 1.013; 1.002 per mm(3) fibrofatty plaque, 95% CI: 1.000 to 1.003; 1.593 per mm3 necrotic core, 95% CI: 1.219 to 2.082; all p < 0.05). Of the 129 culprit lesion precursors identified by coronary CTA, three-fourths exhibited <50% stenosis and 31.0% exhibited HRP.CONCLUSIONS Although ACS increases with %DS, most precursors of ACS cases and culprit lesions are nonobstructive. Plaque evaluation, including HRP, PB, and plaque composition, identifies high-risk patients above and beyond stenosis severity and aggregate plaque burden. Published by Elsevier on behalf of the American College of Cardiology Foundation.
URI
https://www.sciencedirect.com/science/article/pii/S0735109718343717?via%3Dihubhttps://repository.hanyang.ac.kr/handle/20.500.11754/119122
ISSN
0735-1097; 1558-3597
DOI
10.1016/j.jacc.2018.02.079
Appears in Collections:
COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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