背景:高危冠状动脉斑块特征(CPCs)在非血流限制性病变的强化药物治疗或血运重建中的临床价值尚不明确。
目的:作者进行了系统评价和荟萃分析,以研究CPC对患者级和病变级主要心血管不良事件(MACE)的预后影响。
方法:30项研究(21项回顾性研究,9个前瞻性),包括30,369名评估CPC与MACE的相关性的患者。CPC包括高斑块负荷,低最小管腔面积,薄帽纤维粥样瘤,高脂质核心负担指数,低衰减斑块,点状钙化,餐巾环标志,积极的重塑。
结果:在9项研究中使用冠状动脉内方式评估了CPC(4项研究中的光学相干断层扫描,3项研究中的血管内超声成像,2项研究中的近红外光谱血管内超声成像)和21项研究中的冠状动脉计算机断层扫描血管造影。在未经调整和调整的分析中,CPC均显着预测了患者水平和病变水平的MACE。对于大多数CPC来说,MACE的准确性在患者水平为中等至良好,在病变水平为中等至良好.具有超过1个CPC的斑块对于病变水平MACE具有最高的准确性(AUC:0.87)。因为斑块中CPC的患病率很低,病变水平MACE的估计阳性预测值适中.结果在成像模式和临床表现上大多是一致的,在具有普遍困难结果的研究中。
结论:CPC的特征确定了高风险的动脉粥样硬化斑块,使病变和患者处于未来MACE的风险中,尽管敏感性和阳性预测值适中(冠状动脉斑块特征与动脉粥样硬化患者和病变中主要不良心血管事件相关;CRD42021251810)。
The clinical value of high-risk coronary plaque characteristics (CPCs) to inform intensified medical therapy or revascularization of non-flow-limiting lesions remains uncertain.
The authors performed a systematic
review and meta-analysis to study the prognostic impact of CPCs on patient-level and lesion-level major cardiovascular adverse events (MACE).
Thirty studies (21 retrospective, 9 prospective) with 30,369 patients evaluating the association of CPCs with MACE were included. CPCs included high plaque burden, low minimal lumen area, thin cap fibroatheroma, high lipid core burden index, low-attenuation plaque, spotty calcification, napkin ring sign, and positive remodeling.
CPCs were evaluated with the use of intracoronary modalities in 9 studies (optical coherence tomography in 4 studies, intravascular ultrasound imaging in 3 studies, and near-infrared spectroscopy intravascular ultrasound imaging in 2 studies) and by means of coronary computed tomographic angiography in 21 studies. CPCs significantly predicted patient-level and lesion-level MACE in both unadjusted and adjusted analyses. For most CPCs, accuracy for MACE was modest to good at the patient level and moderate to good at the lesion level. Plaques with more than 1 CPC had the highest accuracy for lesion-level MACE (AUC: 0.87). Because the prevalence of CPCs among plaques was low, estimated positive predictive values for lesion-level MACE were modest. Results were mostly consistent across imaging modalities and clinical presentations, and in studies with prevailing hard outcomes.
Characterization of CPCs identifies high-risk atherosclerotic plaques that place lesions and patients at risk for future MACE, albeit with modest sensitivity and positive predictive value (Coronary Plaque Characteristics Associated With Major Adverse Cardiovascular Events Among Atherosclerotic Patients and Lesions; CRD42021251810).