Coronary Computed Tomography Angiography-Based Coronary Risk Stratification in Subjects Presenting With No or Atypical Symptoms
スポンサーリンク
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
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Kondo Makoto
Department of Cardiology, Takase Clinic
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Orihara Tadaaki
Department of Cardiology, Takase Clinic
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Kodama Takahide
Department of Cardiology, Takase Clinic
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Fukazawa Hiroshi
Department of Cardiology, Takase Clinic
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Kondo Takeshi
Department of Cardiology, Takase Clinic
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Takase Shinichi
Department of Cardiology, Takase Clinic
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Yamazaki Junichi
Department of Cardiovascular Medicine, Toho University Omori Medical Center
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Ikeda Takanori
Department Of Cardiovascular Medicine Graduate School Of Medicine Kyoto University
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Oida Akitsugu
Department Of Cardiology Takase Clinic
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Ohida Akitsugu
Department Of Cardiology Takase Clinic
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Narula Jagat
Uc Irvine
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Kondo Makoto
Department Of Cardiology Takase Clinic
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Fukazawa Hiroshi
Department Of Cardiology Takase Clinic
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Orihara Tadaaki
Department Of Cardiology Takase Clinic
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Takase Shinichi
Department Of Cardiology Takase Clinic
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Fukazawa Hiroshi
Department Of Applied Physics Faculty Of Engineering Hokkaido University
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Sugiyama Junichi
Department Of Cardiology Takase Clinic
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Fujimoto Shinichiro
Department Of Cardiology Takase Clinic
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NAGAOKA Hideki
Department of Cardiology, Takase Clinic
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Nagaoka Hideki
Department Of Cardiology Takase Clinic
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Yamazaki Junichi
Department Of Biofunctional Science Faculty Of Agriculture And Life Science Hirosaki University
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Kondo Makoto
Departmen Of Radiology School Of Medicine Keio University
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Kondo Takeshi
Department Of Applied Biological Science Tokyo University Of Agriculture And Technology
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Endo Akira
Department Of Agricultural And Biological Chemistry Tokyo Noko University
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Sugiyama Junichi
Department Of Biophysics And Biochemistry Graduate School Of Science The University Of Tokyo
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Fukazawa Hirosi
Department Of Cardiology Takase Clinic
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NARULA Jagat
Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Cardiovascular Health Center, Mount Sinai School of Medicine
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Ikeda Takanori
Department Of Cardiovascular Medicine Toho University Omori Medical Center
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Narula Jagat
Zena And Michael A. Wiener Cardiovascular Institute And Marie-josee And Henry R. Kravis Cardiovascular Health Center Mount Sinai School Of Medicine
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Endo Akira
Department Of Cardiology Takase Clinic
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