基于CAD-RADS的高危斑块特征联合CT-FFR对冠状动脉临界病变预后的预测价值  

Prognostic value of CAD-RADS-based high-risk plaque features combined with CT-FFR in intermediate coronary stenosis

作　　者：赵建春 龚沈初[2] 张凡 王司晔[3] ZHAO Jianchun;GONG Shenchu;ZHANG Fan;WANG Siye(Department of Radiology,Nantong Tongzhou District People′s Hospital,Jiangsu 226300;Department of Radiology,the Second Affiliated Hospital of Nantong University;Department of Rehabitation Medicine,the Affiliated Hospital of Nantong University)

机构地区：[1]南通市通州区人民医院影像科,江苏226300 [2]南通大学第二附属医院影像科 [3]南通大学附属医院康复医学科

出　　处：《南通大学学报（医学版）》2024年第1期53-58,共6页Journal of Nantong University(Medical sciences)

基　　金：南通市卫生健康委员会科研立项课题(QA2021066)。

摘　　要：目的:研究基于冠状动脉疾病报告和数据系统(coronary artery disease-reporting and data system,CAD-RADS)的高危斑块特征联合CT血流储备分数(fractional flow reserve derived from CT,CT-FFR)对冠状动脉病临界病变患者预后的临床应用价值。方法:在CAD-RADS结构式报告基础上,前瞻性研究冠状动脉CT血管造影(coronary artery CT angiography,CCTA)影像资料和临床资料,共301例临界病变患者纳入研究,影像观察指标包括CAD-RADS≥3、钙化积分≥100、斑块易损性特征、高危斑块、长病变、CT-FFR≤0.8,观察指标的组合包括CAD-RADS≥3 V、CAD-RADS≥3 V且CT-FFR≤0.8。研究终点为预后不良,包括主要不良心血管事件(major adverse cardiovascular events,MACE)及计划外有创冠状动脉造影(invasive coronary angiography,ICA)、血运重建手术,研究样本分为预后良好组和预后不良组。通过统计不同组间数据的差异,评价CAD-RADS高危斑块联合CT-FFR对临界病变患者预后的临床价值。结果:年龄、钙化积分、CAD-RADS类别、斑块易损性特征、高危斑块、长病变、CT-FFR在预后良好组和预后不良组间的差异有统计学意义(P<0.05);CAD-RADS类别、高危斑块、CT-FFR是冠状动脉临界病变预后的独立预测因子(P<0.05);CT-FFR≤0.8在CAD-RADS≥3组、钙化积分≥100组、不同斑块易损性特征组、高危斑块组、长病变组中发生率差异均有统计学意义(均P<0.05);观察指标组合(CAD-RADS≥3 V且CT-FFR≤0.8)预测预后不良的特异性、准确性和阳性预测值分别为97.2%、85.7%、88.7%,AUC为0.795(95%CI:0.731~0.858)。结论:基于CAD-RADS的高危斑块特征联合CT-FFR能有效预测MACE及计划外ICA、血运重建手术,指导临床针对性干预与治疗。Objective:To study the clinical value of coronary artery disease-reporting and data system(CAD-RADS)-based high-risk plaque features combined with fractional flow reserve derived from CT(CT-FFR)in the prognosis of patients with intermediate coronary stenosis.Methods:Based on the CAD-RADS structural reporting,the coronary artery CT angiography(CCTA)imaging and clinical data were prospectively studied,a total of 301 cases with intermediate coronary stenosis were included in the study.Imaging observation indicators include CAD-RADS≥3,agatston score≥100,plaque vulnerability features,high-risk plaques,long lesions,CT-FFR≤0.8.The combination of observation indicators includes CAD-RADS≥3 V,CAD-RADS≥3 V and CT-FFR≤0.8.The end point of the study was poor prognosis,including major adverse cardiovascular events(MACE)and unplanned invasive coronary angiography(ICA),stent implantation,and coronary artery bypass grafting.The study samples were divided into two groups:good prognosis group and poor prognosis group.To evaluate the clinical value of CAD-RADS high-risk plaque combined with CT-FFR in the prognosis of patients with intermediate coronary stenosis by counting the differences of data between different groups.Results:There were significant differences in age,calcification score,CAD-RADS class,plaque vulnerability,high-risk plaque,long lesion,good CT-FFR prognosis group and poor prognosis group(P<0.05).CAD-RADS class,high-risk plaque and CT-FFR were independent predictors of prognosis of intermediate coronary stenosis(P<0.05).The incidence of CT-FFR≤0.8 was significantly different in CAD-RADS≥3 group,calcification score≥100 group, different plaque vulnerability group, high-risk plaque group and long-term disease group(P<0.05). The specificity, accuracy, positive predictive value of the combination of observation indicators(CAD-RADS≥3 V and CT-FFR≤0.8) for predicting poor prognosis were 97.2%, 85.7% and 88.7%, and the AUC value was 0.795(95%CI: 0.731-0.858). Conclusion: CAD-RADS-based high-risk plaque

关 键 词：冠状动脉临界病变 冠状动脉CT血管造影 冠状动脉疾病报告和数据系统 高危斑块 斑块易损性 CT血流储备分数 

分 类 号：R541.4[医药卫生—心血管疾病]