冠状动脉钙化积分与不稳定型心绞痛患者预后的关系  

Relationship between coronary artery calcium sore and the prognosis of patients with unstable angina

作　　者：李韶南[1] 罗义[1] 潘宜智[1] 曾冲[1] 黄慧芳[1] 雷晓明[1] 

机构地区：[1]广州市第一人民医院心血管内科,510180

出　　处：《中国心血管杂志》2013年第4期272-275,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨冠状动脉钙化积分(CCS)与不稳定型心绞痛(UA)患者冠状动脉病变严重程度的关系,以及CCS对经皮冠状动脉介入治疗(PCI)术后UA患者临床预后的预测价值。方法回顾性分析2009年1月至2011年1月首次接受PCI术治疗的466例UA患者资料,入选患者均在术前接受心脏及冠状动脉320层螺旋CT检查并计算CCS。PCI术后对患者进行12个月的随访,记录术后有无死亡、非致命性心肌梗死、靶病变血运重建及再发心绞痛入院等主要心脏不良事件(MACE)。结果入选患者按CCS水平分为CCS≤100、100<CCS≤400和CCS>400组,CCS>400组患者的冠状动脉多支病变比例、B2/C型病变比例及冠状动脉病变Gensini积分均显著高于另外两组患者(47.60%比29.70%比18.30%;45.00%比27.30%比15.70%;56.8±16.9比52.8±13.6比36.7±17.1;均为P<0.05)。随访12个月,Kaplan-Meier生存分析发现,CCS≤100、100<CCS≤400组和CCS>400组患者累积无MACE事件生存率差异有统计学意义(88.2%比84.2%比77.2%,Logrank 8.044,P=0.005),在校正了年龄后,多因素Cox回归分析显示CCS>400是UA患者PCI术后MACE发生的独立预测因子。CCS>400组患者较CCS≤100组术后发生MACE的风险增加4.741倍(RR=4.741,P<0.01)。结论 UA患者CCS水平越高表明冠状动脉病变越严重,CCS升高是接受PCI治疗的UA患者临床预后不良的强有力预测因子。Objective To investigate the predicative value of coronary artery calcification sore （CCS） for the prognosis of patients with unstable angina （UA） who underwent percutaneous coronary intervention （PCI）. Methods The 446 patients with UA who underwent PCI for the first time from January 2009 to January 2011 were analyzed retrospectively. Patients received 320-slice multi-detector row computed tomography scanning before PCI and CCS were measured. After PCI, patients were followed up for 12 months and major cardiac adverse events （ MACE ） were recorded. Results UA Patients were divided into three group according to their CCS levels： CCS≤100 group, CCS 101-400 group and CCS 〉400 group. Patients in CCS 〉 400 group had higher rate in muhivessel disease, B2/C type disease and higher Gensini Sore of coronary artery than the other two groups （47.60% vs. 29. 70% vs. 18.30% ; 45.00% vs. 27.30% vs. 15.70%; 56.8±16.9 vs. 52.8 ±13.6 vs. 36.7±17.1; allP〈0.05）. After 12 months of follow-up, Kaplan-Meier survival analysis showed patients of the three groups had significantly different cumulative non- events survival rates （88.2% vs. 84. 2% vs. 77.2% , Log rank 8. 044, P = 0. 005 ）. Multivariate Cox regression analysis showed the risk of MACE in CCS 〉400 group increased 4. 741 folds compared with CCS ≤ 100 group （RR =4. 471, P 〈0. 01 ）. CCS was a strong independent predictor for clinical prognosis of UApatients treated with PCI. Conclusions UA patients with high CCS are associated with more serious coronary artery diseases. CCS is valuable in predicating the prognosis of UA patients treated with PCI.

关 键 词：冠状动脉钙化积分 冠状动脉疾病 血管成形术 预后 

分 类 号：R541.4[医药卫生—心血管疾病]