Study On Prediction Of Non-obstructive Disease Progression By Pericoronary Adipose Tissue And Coronary Plaque And Construction Of Prediction Model

Objective:To investigate the influence of baseline plaque characteristics and pericoronary fat parameters based on coronary CT angiography on the progression of non-obstructive coronary artery disease and its predictive value.Methods:The data of patients who underwent coronary CTA during their stay in our hospital from January 2012 to June 2022 were analyzed retrospectively.The early coronary CTA results showed non-obstructive coronary artery disease,and the patients who developed acute myocardial infarction,underwent revascularization or the second coronary CTA examination showed progression to severe and above were in the progression group;Coronary CTA results of two times in the same period showed that non-obstructive coronary artery was the control group.The clinical data and coronary CTA-related parameters of the two groups were compared.Draw a nomograph model,analyze the predictive value of coronary CTA parameters on the progression of non-obstructive coronary artery,and evaluate and verify it.Results:In univariate analysis,the gender composition of patients in general clinical data was significantly different between the two groups(P<0.05),but there was no significant difference in age,hypertension,diabetes,dyslipidemia,smoking,statin use and other general clinical data(P>0.05).In the comparison of laboratory examination results,the level of cTnT and Hs-CRP in the patients in the advanced group were higher than those in the control group,and the difference was statistically significant(P<0.05);There was no statistically significant difference between the two groups in the results of TC,TG,HDL,LDL,Lp(a),WBC,NE%,LY%,RBC,Hb,PLT,TBIL,ALT,AST,ALB,UA,CRE,K+,FPG,CK,CK-MB,LDH and other laboratory serological tests(P>0.05).In the coronary CTA image data,there were statistically significant differences between the two groups in the degree of stenosis at baseline,the value of pericoronal FAI,high-risk plaque,punctate calcification and low-density plaque(P<0.05);The plaque length,pericoronal fat volume,total plaque volume,lipid plaque volume,fibrous plaque volume,calcified plaque volume,lipid plaque volume ratio,fibrous plaque volume ratio,calcified plaque volume ratio,lumen volume,plaque load,remodeling index,wall-to-lumen ratio,vascular cross-sectional area at stenosis,total cross-sectional area of plaque,positive remodeling There was no significant difference in coronary CTA indexes such as napkin ring sign(P>0.05).In LASSO regression analysis,pericoronal FAI,degree of stenosis,proportion of fibrous plaque volume,plaque load,characteristics of high-risk plaque,punctate calcification and low-density plaque were selected as the influencing factors.In multivariate regression analysis,pericoronal FAI,punctate calcification and low-density plaque were independent risk factors.A prediction model for predicting the progression of non-obstructive coronary artery disease was constructed by using the R language to jointly predict the parameters of pericoronal fat and plaque characteristics.After verification,the model has good discrimination AUC=0.806(95%CI:0.720-0.891)and goodness of fit χ2=1.309,P=0.520,P>0.05.Conclusion:Pericoronal FAI,punctate calcification and low-density plaque based on coronary CTA are the influencing factors of the progression of non-obstructive coronary artery.The nomogram model has a good discrimination ability,which can provide an economic and effective screening method for early clinical identification of vessels with high probability of progression and high risk of plaque rupture,and provide a certain reference value for early intervention of the screened high-risk population.