Clinical Profiles of Psoriasis Patients With Coronary Artery Calcification and Assessment of Acute Coronary Syndrome Risk Factors Using Coronary Computed Tomography Angiography‐Estimated Fractional Flow Reserve

Psoriasis is frequently associated with comorbidities such as metabolic syndrome and acute coronary syndrome (ACS). Coronary artery calcification (CAC), an independent predictor of coronary events, has been reported to be more prevalent in psoriasis patients than in healthy controls. However, its clinical significance and relationship with ACS risk in psoriasis remain incompletely understood. We conducted a single-center retrospective cross-sectional study involving 89 Japanese patients with psoriasis who underwent chest computed tomography (CT) to assess the presence of CAC. In selected patients with CAC, coronary CT angiography (CCTA) was performed, and the fractional flow reserve derived from CT (FFR_CT) was calculated. Thirty-one patients with CAC were more likely to have psoriasis vulgaris, were older, had lower estimated glomerular filtration rates (eGFR), and exhibited higher hemoglobin A1c (HbA1c) levels compared with those without CAC. Among the 22 patients who underwent CCTA, coronary artery calcium scores (CACS) were positively correlated with Psoriasis Area and Severity Index (PASI) scores, serum C-reactive protein (CRP), and HbA1c levels. FFR_CT was measured in 10 patients with ≥ 40% coronary stenosis; six had FFR_CT value ≤ 0.80, indicating a high risk of ACS. Multivariable logistic regression analysis using a stepwise selection method identified age as the only significant predictor of ACS risk. In conclusion, elderly psoriasis patients with concomitant diabetes mellitus (DM) may have an elevated risk of ACS and could benefit from cardiology referral for cardiovascular risk assessment.