上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

冠状动脉CT造影对非显著冠状动脉病变预后的预测价值

关韶峰1，曲新凯1，韩文正1，焦 静2，李若谷1，戴锦杰1   

  1. 上海交通大学附属胸科医院 1.心内科， 2.放射科， 上海 200030
  • 出版日期:2013-11-28 发布日期:2013-12-03
  • 通讯作者: 曲新凯, 电子信箱: qxkchest@126.com。
  • 作者简介:关韶峰（1978—）， 男， 副主任医师， 博士; 电子信箱: gsf@qq.com。
  • 基金资助:

    上海市卫生局科技发展基金项目（2010091，20114286）

Forecast value of computed tomography coronary angiography for prognosis of patients with non-significant coronary stenosis

GUAN Shao-feng1, QU Xin-kai1, HAN Wen-zheng1, JIAO Jing2, LI Ruo-gu1, DAI Jin-jie1   

  1. 1.Department of Cardiology, 2.Department of Radiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
  • Online:2013-11-28 Published:2013-12-03
  • Supported by:

    Science and Technology Development Foundation of Shanghai Municipal Health Bureau, 2010091, 20114286

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摘要：

目的 对冠状动脉计算机断层成像（CTCA）提示非显著病变的患者进行前瞻性随访，以评价其对预后的指导价值。方法 入选因怀疑冠状动脉病变就诊并接受CTCA检查的患者并进行临床随访，记录患者随访期间的主要心脏不良事件（MACE），包括心源性死亡、非致死性心肌梗死和因胸痛复发入院治疗。分析基线临床危险因素、冠状动脉CT病变程度、斑块性质与MACE间的关系。结果 共847例患者入选并完成临床随访，患者平均年龄为（61.7±12.7）岁，男性占53.8%。CTCA检查结果显示61.3%管腔正常，22.2%为轻度狭窄，16.5%为中度狭窄；患者平均随访时间为（20.3±2.2）个月，随访期间MACE发生率为1.5%。多因素Cox回归分析提示冠状动脉狭窄程度是MACE的惟一预测因素（HR=4.43，95%CI为1.78~11.05，P<0.01）；存在冠状动脉病变较无冠状动脉病变者MACE事件发生率明显增加（P<0.001）。结论 CTCA非显著病变者MACE发生率和冠状动脉病变严重程度相关，CTCA正常和轻度冠状动脉病变者MACE发生率极低。

关键词: 计算机断层成像, 冠心病, 预后

Abstract:

Objective To evaluate forecast value of coronary computed tomography angiography (CTCA) for prognosis of patients with non-significant coronary stenosis. Methods Patients with suspected coronary artery disease underwent CTCA were enrolled and followed up. Cardiovascular clinical endpoints were defined as major adverse cardiac event (MACE) including cardiac death, nonfetal myocardial infarction, and hospitalization due to chest pain. The relationships between MACE and baseline patient characteristics, stenosis severity, and lesion characteristics were evaluated respectively. Results A total of 847 patients (53.8% males) were enrolled, whose mean age was (61.7±12.7) years. CTCA results showed normal lumen in 61.3% patients, mild stenosis in 22.2%, and moderate stenosis in 16.5% patients. During follow-up of (20.3±2.2) months, MACE rate was 1.5%. Multivariate COX hazard regression analysis showed that the severity of lesion in coronary CTCA was the only factor causing MACE (HR=4.43, 95%CI: 1.78-11.05, P<0.01). Compared to patients without coronary lesions, more MACEs occurred in patients with coronary lesions (P<0.001). Conclusion MACE rate in patients with non-significant coronary stenosis detected by CTCA was correlated well to the severity of lesion, while MACE rate was very low in patients with normal and mild coronary lesion.

Key words: computed tomography, coronary artery disease, prognosis