Predictive Value Of Coronary Plaque Characteristics Of 256-slice CTA In Major Adverse Cardiac Events

Objective: To investigate the clinical value of Plaque characteristics detected by coronary-computed tomography angiography(CCTA)in Predicting major adverse cardiac events(MACE).Methods: A retrospective analysis of 256-slice coronary CTA from December 2016 to June 2018 in our hospital was made and 809 patients with plaque were found.The patients were followed up,the occurrence of MACE was recorded,and the characteristics of coronary CTA images were analyzed,including the degree of coronary stenosis(mild stenosis 1-49%,moderate stenosis 50-69%,severe stenosis(> 70%)and vulnerable plaques(low CT attenuation,positive remodeling,punctate calcification,napkin ring sign)and the general data of patients(age,sex,hypertension,diabetes,dyslipidemia,smoking).According to the follow-up results,the patients were divided into MACE group and non-MACE group.The differences of basic clinical features and plaque characteristics between the two groups were compared,and the factors related to the occurrence of MACE were analyzed by logistic regression.Results: 1.192(23.73%)patients were lost to follow-up,617 patients successfully completed the follow-up.Among them,74 patients had MACE during the follow-up(including 2 cases of non-fatal myocardial infarction,1case of sudden cardiac death,42 cases of angina requiring hospitalization and29 cases of revascularization).The remaining 543 patients did not have MACE until the end of the follow-up.2.Analysis of plaque characteristics:(1)In mild,moderate and severe coronary stenosis,mild stenosis was 73.85% in non-MACE group,higher than 9.46% in MACE group(P < 0.05);moderate and severe stenosis was 33.78% and 56.76% in MACE group,respectively,higher than 16.94% and 9.21% in non-MACE group(P < 0.05).(2)Vulnerable plaques: 51 of 74 patients with MACE had Vulnerable plaques and 23 had no Vulnerable plaques;117 of 543 patients without MACE had vulnerable plaques and 426 patients had no vulnerable plaques.There were significant differences between the two groups(P < 0.05);there were significant differences in attenuated plaques,positive remodeling,punctate calcification and napkin ring sign between the two groups(P < 0.05).3.Analysis of plaque characteristics:(1)In mild,moderate and severe coronary stenosis,there was significant difference between MACE group and non-MACE group(P < 0.05).(2)Vulnerable plaques: 51 of 74 patients with MACE had vulnerable plaques(36with low CT attenuation,23 with positive remodeling,22 with punctate calcification,7 with napkin ring sign),and 23 without vulnerable plaques.Among 543 patients without MACE,117 had vulnerable plaques(62had low CT attenuation,67 had positive remodeling,85 had punctate calcification,19 had napkin ring sign),and 426 had no vulnerable plaques.The difference between the two groups was statistically significant(P < 0.05).3.Logistic multivariate regression analysis showed that mild stenosis,moderatestenosis,severe stenosis,low CT attenuation,positive reconstruction and napkin ring sign were independently associated with the occurrence of MACE.Conclusions: Male,hypertension,diabetes mellitus,smoking,stenosis,low CT attenuation plaque,positive remodeling,punctate calcification and napkin ring sign were different between MACE group and non-MACE group.Moderate stenosis,severe stenosis and low CT attenuation,positive remodeling and napkin ring sign indicated that major adverse cardiac events were more likely to occur in the future.Coronary plaque characteristics of256-slice CTA have potential value in predicting future occurrence of MACE.