Rationale and Objectives
The aims of this study were to assess the prevalence of noncalcified coronary plaques in asymptomatic patients and to investigate the risk factors.
Materials and Methods
In this study, 584 patients were recruited prospectively. Patients were classified as having low, intermediate, or high pretest likelihoods of coronary artery disease according to the Morise score. Coronary computed tomographic angiography was performed in all patients using a 320–detector row dynamic-volume computed tomographic scanner. Imaging reconstruction was performed, and the postprocessed data were analyzed. Logistic regression analysis was used to evaluate the relationship between risk factors and the presence of noncalcified plaque.
Results
Coronary computed tomographic angiography revealed noncalcified plaques in 38.3% of all patients (224 of 584). The prevalence of noncalcified plaques was significantly higher in patients with calcium scores > 0 ( P < .001). Significant differences were found between the degrees of luminal stenosis among patients with low, intermediate, and high pretest likelihoods of coronary artery disease ( P = .001), while the prevalence of noncalcified plaques did not differ with the Morise score ( P = .08). Noncalcified plaque was associated with hypercholesterolemia ( P = .02) and diabetes mellitus ( P = .002). Age ( P = .47), gender ( P = .58), estrogen status ( P = .55), smoking ( P = .22), hypertension ( P = .27), and family history ( P = .09) did not differ between patients with and those without noncalcified plaques.
Conclusions
Hypercholesterolemia and diabetes mellitus are high risk factors for the prevalence of noncalcified plaques for asymptomatic patients.
Pathologic studies have demonstrated that disruption or erosion of vulnerable plaques and subsequent thrombosis are among the most frequent causes of acute coronary syndromes (ACS) .
Previous studies have proven that the composition of coronary plaques, rather than the degree of stenosis, is closely associated with the occurrence of ACS . Therefore, an assessment of plaque components and stability is critical for the clinical prevention of ACS. Although invasive coronary angiography (ICA) can provide a direct visualization of the plaque surface and intraluminal structures, it cannot distinguish the various components of plaques. Intravascular ultrasound has been proven to be an effective approach to detect the composition of plaques . However, ultrasound has been restrained from widespread clinical applications because of its complexity, expense, and invasiveness. In recent years, computed tomographic (CT) angiography (CTA) has been regarded as an emerging noninvasive technique for coronary plaque detection and evaluation. Although considered highly sensitive to calcification, CTA has also been found useful for evaluating noncalcified plaques . Previous studies using coronary CTA have confirmed the correlation between noncalcified components and the vulnerability of plaques . In some studies, noncalcified coronary plaques have also been demonstrated to be an important risk factor for ACS .
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Materials and methods
Study Population
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CT Protocol
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Reconstruction Method
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CT Data Analysis
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Statistical Analysis
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Results
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Table 1
Baseline Characteristics of the Study Patients ( n = 584)
Variable Value Age (y) 58.3 ± 10.7 Men/women 316/268 Average body mass index (kg/m 2 ) 24.2 ± 2.7 Diabetes mellitus 286 (49.0%) Hypertension 278 (47.6%) Hypercholesterolemia 326 (55.8%) Family history of CAD 316 (54.1%) Female estrogen status (positive/negative) 138/130 Smoking 212 (36.3%) Pretest likelihood of CAD Low 204 (34.9%) Intermediate 300 (51.4%) High 80 (13.7%)
CAD, coronary artery disease.
Data are expressed as mean ± standard deviation or as number (percentage).
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Table 2
Univariate and Multivariate Logistic Regression Demonstrating Associations of Risk Factors with Presence of Noncalcified Plaque
Variable Univariate Logistic Regression Multivariate Logistic Regression OR 95% CI_P_ OR 95% CI_P_ Age 0.98 0.87–1.12 .80 0.95 0.81–1.10 .47 Gender 0.61 0.38–0.99 .04 0.86 0.50–1.47 .58 Body mass index 1.88 1.17–3.03 .01 1.10 0.99–1.21 .07 Diabetes mellitus 2.74 1.68–4.48 <.001 2.42 1.40–4.18 .002 Hypertension 1.56 0.97–2.51 .07 1.35 0.79–2.23 .27 Hypercholesterolemia 1.99 1.22–3.24 .006 1.94 1.12–3.38 .02 Family history 0.91 0.57–1.46 .70 0.62 0.36–1.09 .09 Estrogen status 0.96 0.67–1.35 .80 1.14 0.75–1.71 .55 Smoking 1.88 1.17–3.04 .01 1.41 0.82–2.44 .22
CI, confidence interval; OR, odds ratio.
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Discussion
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