联合应用定量冠状动脉造影和心血管病危险因素筛选高危临界病变患者的初步研究

目的 探讨联合应用定量冠状动脉(冠脉)造影(QCA)和心血管病危险因素预测临界病变患者近期心血管事件发生的可行性,以期建立有效预警模型筛选高危临界病变患者.方法 选择18～80岁男性或未怀孕妇女、冠脉造影发现狭窄程度为20%～70%、愿意签署知情同意书的临界病变患者.由专业医师接诊,询问相关病史和体格检查,由专业心血管介入医师按照标准方法进行冠脉造影.采用思创科技(Create Life)医学影像工作站V3.1版进行QCA分析.终点事件的定义为心源性死亡、非致死性心肌梗死及不稳定心绞痛.结果 共纳入1137例患者,在12个月随访期内,出现终点事件者为124例,其中心肌梗死26例,不稳定心绞痛98例,无心源性死亡病例.事件发生组高敏C反应蛋白(hsCRP)稍高于无事件发生组(P=0.03),事件发生组与对照组Framingham Risk Score分层构成比有明显差异.Cox回归分析发现Framingham Risk Score、钙化及斑块面积与终点事件发生相关.将QCA积分和Framingham Risk Score采用logistic回归产生的变量进行ROC曲线分析,并以最佳截切点分组进行生存分析,经Log Rank分析发现,两组生存曲线差异有统计学意义(91.74% vs. 81.32%,P=0.0385).结论 Framingham Risk Score和QCA表现(钙化及斑块面积)与临界病变患者心血管事件发生相关,两者联合应用可提高筛选高危临界病变患者的效能.

Using the combination of traditional risk factors and quantitative coronary angiography ( QCA) in predicting the risk of individuals with subclinical artherosclerosis

Objective To determine whether the combination of traditional risk factors and quantitative coronary angiography (QCA) assessment could provide accurate prognostic information on a population-based study including 1137 adults with subclinical artherosclerosis and with coronary risk factors. Methods Participants underwent coronary angiography examination before the minimal stenotic diameters, segment diameters, percent stenosis, plaque areas. Other parameters were analyzed by the computer-assisted Coronary Angiography Analysis System. The Framingham Risk Score for each participant was assessed. During the 1 year follow-up period, all kinds of endpoint cardiovascular events were screened. Endpoint events were defined as death from coronary heart disease, nonfatal myocardial infarction (MI) or unstable angina pectoris. Results During the 1 year of follow-up period, a total of 124 participants developed an endpoint event, which was significantly associated with the Framingham Risk Score, calcium of plaques and the plaque areas (all Ps＜0.05).The QCA score incorporated with the QCA parameters was related to the endpoint events. The Framingham Risk Score was combined with QCA score through logistic regression for prediction of end-point events. Data from the ROC analysis showed the accuracy of this prediction algorithm was superior to the accuracy when variables themselves were used. The event-free survival rate was inferior to the control group in participates under high risk, when being screened with this prediction algorithm (P＜0.05). Conclusion The risk of cardiovascular attack in subclinical artherosclerosis individual seemed to be associated with the Framingham Risk Score, calcium of plaques and the plaque areas. When the traditional risk factors (the Framingham Risk Score) were combined with QCA, the new method could provide more prognostic information on those adults with subclinical artherosclerosis.