Coronary computed tomography plaque-based scores predict long-term cardiovascular events.

OBJECTIVES: Coronary computed tomography angiography (coronary CTA) scores based on luminal obstruction, plaque burden, and characteristics are used for prognostication in coronary artery disease (CAD), such as segmental stenosis and plaque extent involvement and Gensini and Leaman scores. The use of coronary CTA scores for the long-term prognosis remains not completely defined. We sought to evaluate the long-term prognosis of CTA scores for cardiovascular events in symptomatic patients with suspected CAD. METHODS: The presence and extent of CAD were evaluated by coronary CTA in patients from two multicenter prospective studies, which were classified according to several coronary CTA scores. The primary endpoint was major adverse cardiac events (MACE). Two hundred and twenty-two patients were followed up for a median of 6.8 (6.3-9.1) years, and 73 patients met the composite endpoints of MACE. RESULTS: Compared to the clinical prediction model, the highest model improvement was observed when added obstructive CAD. After adjustment for the presence of obstructive CAD, the segment involvement score for non-calcified plaque (SISNoncalc) was independently associated with MACE, presenting incremental prognostic value over clinical data and CAD severity (χ2 39.5 vs 21.2, p < 0.001 for comparison with a clinical model; and χ2 39.5 vs 35.6, p = 0.04 for comparison with clinical + CAD severity). Patients with obstructive CAD and SISNoncalc > 3 were likely to experience events (HR 4.27, 95% CI 2.17-4.40, p < 0.001). CONCLUSIONS: Coronary CTA plaque-based scores provide incremental long-term prognostic value for up to 7 years. Among patients with obstructive CAD, the presence of extensive non-calcified disease (> 3 coronary segments) is associated with increased cardiovascular risk for late events independently of the presence of obstructive CAD. KEY POINTS: • Coronary CTA plaque-based scores are long-term prognostic markers in patients with stable CAD. • Besides obstructive CAD, the segment involvement score of non-calcified disease of 3 or more independently increased the risk of cardiovascular events.

Diminished cholesterol efflux mediated by HDL and coronary artery disease in young male anabolic androgenic steroid users.

BACKGROUND AND AIMS: Anabolic androgenic steroids (AAS) have been associated with coronary artery disease (CAD). AAS abuse leads to a remarkable decrease in high-density lipoprotein (HDL) plasma concentration, which could be a key factor in the atherosclerotic process. Moreover, not only the concentration of HDL, but also its functionality, plays a pivotal role in CAD. We tested the functionality of HDL by cholesterol efflux and antioxidant capacity. We also evaluated the prevalence of CAD in AAS users. METHODS: Twenty strength-trained AAS users (AASU) age 29 ±â€¯5 yr, 20 age-matched strength-trained AAS nonusers (AASNU), and 10 sedentary controls (SC) were enrolled in this cross-sectional study. Functionality of HDL was evaluated by 14C-cholesterol efflux and the ability of HDL in inhibiting LDL oxidation. Coronary artery was evaluated with coronary computed tomography angiography. RESULTS: Cholesterol efflux was lower in AASU compared with AASNU and SC (20 vs. 23 vs. 24%, respectively, p < 0.001). However, the lag time for LDL oxidation was higher in AASU compared with AASNU and SC (41 vs 13 vs 11 min, respectively, p < 0.001). We found at least 2 coronary arteries with plaques in 25% of AASU. None of the AASNU and SC had plaques. The time of AAS use was negatively associated with cholesterol efflux. CONCLUSIONS: This study indicates that AAS abuse impairs the cholesterol efflux mediated by HDL. Long-term AAS use seems to be correlated with lower cholesterol efflux and early subclinical CAD in this population.

Doença de tronco de coronária esquerda: avanços recentes no diagnóstico e tratamento / Disease of left main coronary artery: recent advances in diagnosis and treatment

Desde a sua primeira descrição, em 1912, por James Herrick, em paciente jovem com infarto do miocárdio e choque cardiogênico, o acometimento aterosclerótico obstrutivo do tronco de coronária esquerda representa um desafio para cardiologistas clínicos, cirurgiões e intervencionistas. Os riscos associados a essa lesão são conhecidos desde os primórdios da angiografia, quando se percebeu que pacientes com obstruções coronárias nesse local apresentavam maior mortalidade no seguimento clínico. Desde essa época, recomenda-se que a revascularização miocárdica cirúrgica seja o tratamento de escolha em pacientes com lesões angiograficamente obstrutivas no tronco de coronária esquerda. Diversos avanços ocorridos no âmbito da cardiologia nas últimas décadas têm contribuído para importantes mudanças no diagnóstico, prognóstico e tratamento de portadores de lesões de tronco. O emprego do ultrassom intracoronário e da reserva fracionada de fluxo para avaliação de lesões ambíguas nessa localização, o incremento do tratamento farmacológico com antiplaquetários e estatinas, e o surgimento de stents farmacológicos constituem alguns desses avanços...

Doença de tronco de coronária esquerda: avanços recentes no diagnóstico e tratamento / Disease of left main coronary artery: recent advances in diagnosis and treatment

Desde a sua primeira descrição por James Herrick em 1912 - em paviente jovem com infarto do miocário e choque cardiogênico o acometimento aterosclerótico obstrutivo do tronco de coronária esquerda (TCE) representa um desafio para cardiologistas clínicos, cirurgiões e intervencionistas . Os riscos associados a esta lesão são conhecidos desde os primórdios da angiografia, quando percebeu-se que pacientes com obstruções coronárias neste local apresentavam maior mortalidade no seguimento clínico...