冠状动脉CT血管造影提示临界病变有易损斑块患者预后分析

目的: 分析冠状动脉CT血管造影（CCTA）提示临界病变含有易损斑块患者的预后。方法: 回顾性分析2015年2月2日至9月13日在浙江大学医学院附属邵逸夫医院行CCTA检查提示为临界病变（直径狭窄50%~70%）且不需要介入治疗的患者1963例（2728处病变）。根据CCTA提示的斑块性质分为易损斑块组（804例）和稳定斑块组（1159例）。以发生主要不良心血管事件（MACE，包括心源性死亡、非致死性急性心肌梗死及靶病变血运重建）为观察终点，比较两组的预后。结果: 平均随访（27.4±2.3）个月，易损斑块组MACE发生率高于稳定斑块组（分别为10.8%和2.3%，P < 0.01），调整年龄、性别、吸烟、高血压病、糖尿病、高脂血症等进行多因素分析显示，易损斑块组发生MACE的风险比（HR）为5.022（95% CI：3.254~7.751，P < 0.01）。亚组分析提示，易损斑块未服药组（服用抗血小板及他汀类药物3个月及以下）和易损斑块服药组（服用抗血小板及他汀类药物3个月以上）MACE发生率分别为17.0%和5.8%，易损斑块未服药组发生MACE的风险增加（HR=3.149，95% CI：1.987~4.992，P < 0.01）；而稳定斑块组未观察到此差异（HR=1.721，95% CI：0.798~3.712，P>0.05）。结论: CCTA提示临界病变含有易损斑块的患者危险性更高，而药物治疗主要作用于易损斑块，对稳定斑块是否有效有待进一步讨论。

Prognosis of patients with vulnerable plaques indicated by coronary CT angiography

Objective: To investigate the prognosis of patients with vulnerable plaque indicated by coronary CT angiography (CCTA). Methods: Totally 1963 patients underwent CCTA from February 2nd 2015 to September 13th 2015, and 2728 coronary borderline lesions (stenosis of 50%-70%) were detected. Among them 804 patients had vulnerable plaques and 1159 patients had stable plaques. The primary endpoint was major cardiac adverse events (MACE), including cardiac death, acute myocardial infarction and target lesion revascularization. Results: Patients were followed up for a mean follow-up of 27.4±2.3 months. The incidence of MACE in the vulnerable plaque group was significantly higher than that in the stable plaque group (10.8%vs 2.3%, P < 0.01). After adjusting for age, gender, smoking, hypertension, diabetes, hyperlipidemia, the MACE hazard ratio (HR) in the vulnerable plaque group was 5.022 (95% CI:3.254-7.751, P < 0.01).Subgroup analysis showed that in the vulnerable plaque group, the incidence of MACE in patients taking antiplatelet and statin ≤3 months and those taking antiplatelet and statin > 3 months was 17.0%and 5.8%, respectively (HR=3.149, 95% CI:1.987-4.992, P < 0.01); but the difference did not seen in stable plaque group (HR=1.721, 95% CI:0.798-3.712, P>0.05). Conclusion: This study confirmed the risk of MACE in patients with vulnerable plaque detected by CCTA and the drug treatment may reduce the risk for patients with vulnerable plaque.