基于冠状动脉CT血管成像的慢性完全闭塞病变评分在介入治疗中的预测价值

目的探讨基于冠状动脉CT血管成像(CCTA)的慢性完全闭塞病变(CTO)评分对经皮冠状动脉介入治疗(PCI)最终结果的预测价值。方法回顾性搜集2016年2月至2018年8月福建医科大学省立临床医学院行CCTA检查,并经冠状动脉造影检查确诊为CTO患者共66例,分为PCI成功组(48例)和PCI失败组(18例),采用两个独立样本t检验比较两组间年龄、BMI、CTO闭塞段钙化积分、CTO闭塞段内钙化位置和范围的差异;采用卡方检验或Fisher精确概率法比较相关病史的组间差异以及闭塞段近端形态、钙化、弯曲度、闭塞段长度对介入治疗结果的影响。计算基于CCTA的J-CTO评分(J-CTOCT),同时将J-CTO评分系统中钙化进一步分为钙化程度(轻度、重度)、钙化范围(全段、部分)重新计算改良-CTO评分(改良-CTOCT),利用受试者操作特征曲线(ROC)评价二者对CTO介入结果的预测效能。结果两组患者间基本临床资料差异无统计学意义。与PCI成功组相比,PCI失败组在闭塞段近端钝形形态、闭塞段长度>20 mm、弯曲度>45°的发生率明显增高(χ2值分别为5.012、3.999和4.103,P<0.05)。在PCI失败组,闭塞段钙化发生率也明显增高(P<0.05),其中闭塞段全段钙化(P=0.001)、闭塞段重度钙化(P=0.000)的发生率明显增高,而闭塞段轻度钙化在PCI成功组发生率较高(P=0.141)。闭塞段钙化位置、钙化积分及钙化范围均差异无统计学意义(P>0.05)。改良-CTOCT在预测CTO介入成功率的ROC曲线下面积(0.921)高于J-CTOCT(0.847),差异具有统计学意义(P<0.001)。结论CTO病变PCI术前CCTA形态学评估有助于预测PCI手术成功率,基于CCTA的改良-CTOCT评分较J-CTOCT评分有更高的预测价值。

Predictive value of chronic total occlusion score based on coronary CT angiography in interventional treatment of chronic total occlusion of coronary artery

Objective To explore the predictive value of modified chronic total occlusion(CTO)scores based on coronary computed tomography angiography(CCTA)for the outcome of CTO lesions after percutaneous coronary intervention(PCI).Methods A total of sixty-six patients who had undergone CCTA examinations were retrospectively enrolled and divided into PCI-success group(n=48)and PCI-failure group(n=18).Age,body mass index(BMI),calcium score(CACS),location and extent of CTO occlusive segments were recorded and compared between the two groups using paired-samples t test.In addition,the differences of gender,hypertension,hyperlipidemia,hyperuricemia,diabetes mellitus,myocardial infarction and angina pectoris were analyzed by using chi-square test and Fisher exact test.J-CTO score based on CCTA images(J-CTOCT)was calculated.Furthermore,modified-CTO score(m-CTOCT)was measured by redefining the calcification degree(mild,severe)and range(full segment,part)in the J-CTO scoring system.Predictive value of J-CTOCT and m-CTOCT on recanalization success was evaluated by the receiver operating curve(ROC)analysis.Results There were no significant differences in patients′clinical indices between the two groups(all P>0.05).Compared to PCI-success group,blunt cap,blending>45 degrees,lesion length>20 mm,full calcification segment of lesion(χ2=5.012,3.999 and 4.103,respectively;P<0.05)occurred more frequently in the PCI-failure group.In addition,the incidence of occlusive calcification was significantly increased in the PCI-failure group(P<0.05),as well as the total occlusive calcification(P=0.001)and severe occlusive calcification(P=0.000).Nevertheless,the rate of mild occlusive calcification was significantly higher in the PCI-success group(P=0.037).There were no significant differences in calcification location,calcification score and extent of calcification(P>0.05)between the two groups.The area under ROC(AUC)of m-CTOCT(0.921)was significantly higher than that of J-CTOCT(0.847,P<0.001).Conclusions Morphological evaluation of CCTA is helpful to predict the surgical success in patients with PCI.m-CTOCT scoring shows higher predictive value compared to traditional J-CTOCT score.