Coronary Computed Tomography Angiography-Based Coronary Risk Stratification in Subjects Presenting With No or Atypical Symptoms

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概要

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• Background: Coronary computed tomography angiography (CTA) findings of positive vessel remodeling and low-attenuation plaque, referred to as computed tomography-verified high-risk plaque (CT-HRP), have been reported to be associated with the development of subsequent acute coronary syndromes. The aim of this study was to examine the usefulness of coronary CTA for coronary risk re-stratification of patients with asymptomatic and atypical chest symptoms. Methods and Results: A total of 1,139 subjects (M/F 602/537; mean age, 61.5±9.3 years) who were either asymptomatic or presented with atypical chest symptoms underwent coronary 64- or 320-slice multidetector computed tomography angiography and Agatston score. Age, sex, coronary risk factors, including hypertension, diabetes mellitus (DM), dyslipidemia, and smoking were investigated as predictors for CT-HRP on multivariate analysis using logistic regression analysis. CT-HRP was observed in 72 patients (6.3%). Based on Framingham risk scores (FRS), CT-HRP was observed in 0/94 subjects (0.0%) in the low-risk group, 35/806 (4.3%) in the intermediate-risk group, and 37/239 (15.5%) in the high-risk group. On logistic regression analysis significant predictors for CT-HRP in intermediate- and high-risk subjects were male sex (odds ratio [OR] 2.829; 95% confidence interval [CI] 1.460–5.479, P=0.0021), DM (OR 2.418; 95% CI 1.420–4.116, P=0.0011), and current smoking (OR 1.922; 95% CI 1.096–3.371, P=0.0160). CT-HRP prevalence for Agatston scores >500 and >250 was lower in the intermediate- and high-risk groups, respectively. Conclusions: In asymptomatic subjects and those presenting with atypical chest pain who have a more than an intermediate risk, coronary CTA is contributory to FRS. Male sex, DM and smoking were independent predictors of vulnerable plaque in the more than intermediate-risk group.  (Circ J 2012; 76: 2419–2425)

• 2012-09-25

著者

• Kondo Makoto

  Department of Cardiology, Takase Clinic

• Orihara Tadaaki

  Department of Cardiology, Takase Clinic

• Kodama Takahide

  Department of Cardiology, Takase Clinic

• Fukazawa Hiroshi

  Department of Cardiology, Takase Clinic

• Kondo Takeshi

  Department of Cardiology, Takase Clinic

• Takase Shinichi

  Department of Cardiology, Takase Clinic

• Yamazaki Junichi

  Department of Cardiovascular Medicine, Toho University Omori Medical Center

• Ikeda Takanori

  Department Of Cardiovascular Medicine Graduate School Of Medicine Kyoto University

• Oida Akitsugu

  Department Of Cardiology Takase Clinic

• Ohida Akitsugu

  Department Of Cardiology Takase Clinic

• Narula Jagat

  Uc Irvine

• Kondo Makoto

  Department Of Cardiology Takase Clinic

• Fukazawa Hiroshi

  Department Of Cardiology Takase Clinic

• Orihara Tadaaki

  Department Of Cardiology Takase Clinic

• Takase Shinichi

  Department Of Cardiology Takase Clinic

• Fukazawa Hiroshi

  Department Of Applied Physics Faculty Of Engineering Hokkaido University

• Sugiyama Junichi

  Department Of Cardiology Takase Clinic

• Fujimoto Shinichiro

  Department Of Cardiology Takase Clinic

• NAGAOKA Hideki

  Department of Cardiology, Takase Clinic

• Nagaoka Hideki

  Department Of Cardiology Takase Clinic

• Yamazaki Junichi

  Department Of Biofunctional Science Faculty Of Agriculture And Life Science Hirosaki University

• Kondo Makoto

  Departmen Of Radiology School Of Medicine Keio University

• Kondo Takeshi

  Department Of Applied Biological Science Tokyo University Of Agriculture And Technology

• Endo Akira

  Department Of Agricultural And Biological Chemistry Tokyo Noko University

• Sugiyama Junichi

  Department Of Biophysics And Biochemistry Graduate School Of Science The University Of Tokyo

• Fukazawa Hirosi

  Department Of Cardiology Takase Clinic

• NARULA Jagat

  Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Cardiovascular Health Center, Mount Sinai School of Medicine

• Ikeda Takanori

  Department Of Cardiovascular Medicine Toho University Omori Medical Center

• Narula Jagat

  Zena And Michael A. Wiener Cardiovascular Institute And Marie-josee And Henry R. Kravis Cardiovascular Health Center Mount Sinai School Of Medicine

• Endo Akira

  Department Of Cardiology Takase Clinic

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