冠状动脉CT血管成像与非梗阻性冠状动脉疾病患者预后的关系  

Relationship between coronary CT angiography and prognosis in patients with non-obstructive coronary artery disease

作　　者：罗帆 田婷 罗俊一[1] 仇雅靖 张桐 张雪鹤 李晓梅[1] 杨毅宁 LUO Fan;TIAN Ting;LUO Jun-yi;QIU Ya-jing;ZHANG Tong;ZHANG Xue-he;LI Xiao-mei;YANG Yi-ning(Heart Center,the First Affiliated Hospital of Xinjiang University,Urumqi 830000,China;Department of Cardiology,People’s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830000,China)

机构地区：[1]新疆医科大学第一附属医院心脏中心,新疆维吾尔自治区乌鲁木齐市830000 [2]新疆维吾尔自治区人民医院心内科,新疆维吾尔自治区乌鲁木齐市830000

出　　处：《中国心血管病研究》2023年第4期309-316,共8页Chinese Journal of Cardiovascular Research

基　　金：新疆维吾尔自治区科技攻关项目(2020B03002、2020B03002-1)。

摘　　要：目的 探究冠状动脉CTA(CCTA)对非梗阻性冠状动脉疾病(CAD)患者主要不良心脑血管事件(MACCE)和全因死亡的预测价值。方法 纳入2014年1月至2019年12月于新疆医科大学第一附属医院行CCTA检查诊断为非梗阻性CAD患者。回顾性收集患者临床资料、CCTA资料,并通过电话访谈、医院就诊记录查询等多种途径对患者进行随访,中位随访时间为3.7(2.1,5.6)年。最终纳入患者3828例(失访131例)。CCTA参数包括冠状动脉钙化(CAC)评分、斑块类型以及冠状动脉轻度狭窄累及冠状动脉节段数。根据Agatston评分方法测得CAC评分并将患者分为<100(2614例)、100-399(946例)、≥400组(268例);根据CCTA测得冠状动脉斑块类型将患者分为钙化斑块(459例)、混合斑块(2981例)、非钙化斑块组(352例);根据美国心脏协会冠状动脉分段标准计算患者的狭窄节段数,并将患者分为0个(516例)、1~3个(2673例)、4~6个(590例)、≥7个狭窄节段组(49例)。分析不同CCTA参数与MACCE和全因死亡的相关性以及CCTA各参数联合对MACCE和全因死亡的预测价值。结果 与非MACCE组相比,MACCE组患者CAC评分更高(109.8比42.2),狭窄节段数更多(3个比2个),非钙化斑块占比更高(33.1%比8.6%)。与非死亡组相比,死亡组患者CAC评分更高(123.3比42.7),狭窄节段数更多(3比2),非钙化斑块占比更高(41.8%比8.6%)。多因素Cox回归分析显示,CAC评分≥400(MACCE HR=2.641;死亡HR=3.062)、狭窄节段数≥7个(MACCE HR=8.509;死亡HR=4.005)和非钙化斑块存在(MACCE HR=4.981;死亡HR=7.079)是MACCE和死亡的独立危险因素(P均<0.05)。ROC曲线提示,CCTA各参数联合对MACCE和死亡的预测价值最高,ROC曲线下面积(AUC)分别为0.740和0.775。在此基础上增加年龄,模型预测能力进一步提升,AUC分别达到0.771和0.847。结论 CCTA各参数联合应用对非梗阻性CAD患者MACCE和全因死亡有良好的预测能力,增加年龄指标后模型预测能力进一步提升Objective To explore the predictive value of coronary artery CTA(CCTA)for major adverse cardiac and cerebrovascular events(MACCE)and all-cause death in patients with non-obstructive coronary artery disease(CAD).Methods Patients diagnosed with non-obstructive CAD who underwent CCTA examination in the First Affiliated Hospital of Xinjiang Medical University from January 2014 to December 2019 were included.The clinical data and CCTA data of the patients were collected,and the patients were followed up by telephone interviews,hospital diagnosis and treatment records and other ways.The median follow-up time was 3.7(2.1,5.6)years.A total of 3828 patients were enrolled(131 were lost to follow-up).CCTA parameters included coronary artery calcium(CAC)scores,plaque type,and the number of coronary segments with mild coronary stenosis.CAC scores were measured according to the Agatston scoring method;the patients were divided into<100 groups(2614 cases),100-399 groups(946 cases)and≥400 groups(268 cases).According to the coronary plaque types measured by CCTA,the patients were divided into the calcified plaque groups(459 cases),mixed plaque groups(2,981 cases)and non-calcified plaque groups(352 cases).The number of stenosis segments was calculated according to the coronary segmental criteria of the American Heart Association and the patients were divided into 0 stenosis segment(516 cases),1 to 3 stenosis segments(2673 cases),4 to 6 stenosis segments(590 cases)and≥7 stenosis segments(49 cases).The relationship between different CCTA parameters and MACCE and all-cause death and the predictive value of the combined CCTA parameters for MACCE and all-cause death were analyzed.Results Compared with the patients in the non-MACCE group,the patients in the MACCE group had higher CAC scores(109.8 vs.42.2),higher number of stenosis segments(3 vs.2)and higher proportion of non-calcified plaques(33.1%vs.8.6%).Compared with the patients in the non-death group,patients in the death group had higher CAC scores(123.3 vs.42.7),larger number

关 键 词：冠状动脉疾病 体层摄影术 X线计算机 心血管疾病 全因死亡 

分 类 号：R514.4[医药卫生—内科学]