冠状动脉CT造影对非显著冠状动脉病变预后的预测价值

目的对冠状动脉计算机断层成像（CTCA）提示非显著病变的患者进行前瞻性随访，以评价其对预后的指导价值。，方法入选因怀疑冠状动脉病变就诊并接受CTCA检查的患者并进行临床随访，记录患者随访期间的主要心脏不良事件（MACE），包括心源性死亡、非致死性心肌梗死和因胸痛复发人院治疗。分析基线临床危险因素、冠状动脉CT病变程度、斑块性质与MACE间的关系。结果共847例患者入选并完成临床随访，患者平均年龄为（61．7±12．7）岁，男性占53．8％。CTCA检查结果显示61．3％管腔正常，22．2％为轻度狭窄，16．5％为中度狭窄；患者平均随访时间为（20．3±2．2）个月，随访期间MACE发生率为1．5％。多因素Cox回归分析提示冠状动脉狭窄程度是MACE的惟一预测因素（HR=4．43，95％CI为1．78～11．05，P〈0．01）；存在冠状动脉病变较无冠状动脉病变者MACE事件发生率明显增加（P〈0．001）。结论CTCA非显著病变者MACE发生率和冠状动脉病变严重程度相关，CTCA正常和轻度冠状动脉病变者MACE发生率极低。

Forecast value of computed tomography coronary angiography for prognosis of patients with non-significant coronary stenosis

Objective To evaluate forecast value of coronary patients with non-significant coronary stenosis. Methods computed tomography angiography （CTCA） for prognosis of Patients with suspected coronary artery disease underwent CTCA were enrolled and followed up. Cardiovascular clinical endpoints were defined as major adverse cardiac event （MACE） including cardiac death, non-fetal myocardial infarction, and hospitalization due to chest pain. The relationships between MACE and baseline patient characteristics, stenosis severity, and lesion characteristics were evaluated respectively. Results A total of 847 patients （53.8% males） were enrolled, whose mean age was （61.7±12.7） years. CTCA results showed normal lumen in 61.3% patients, mild stenosis in 22.2%, and moderate stenosis in 16.5% patients. During follow-up of （20.3 ± 2.2） months, MACE rate was 1.5%. Multivariate COX hazard regression analysis showed that the severity of lesion in coronary CTCA was the only factor causing MACE （HR = 4.43, 95% Ch 1.78 - 11.05, P 〈 0.01）. Compared to patients without coronary lesions, more MACEs occurred in patients with coronary lesions （ P 〈 0. 001） . Conclusion MACE rate in patients with non-significant coronary stenosis detected by CTCA was correlated well to the severity of lesion, while MACE rate was very low in patients with normal and mild coronary lesion.