冠状动脉CTA斑块特征评价支架内再狭窄风险

目的 探讨冠状动脉CTA斑块特征评估植入支架后发生支架内再狭窄（ISR）的风险。方法 对166例患者于支架植入前行冠状动脉CTA检查，观察血管狭窄程度和斑块特征，并于植入支架后6~18个月内复查冠状动脉造影；根据有无ISR，将其分为ISR组（n=16）与无ISR组（n=150），比较两组间的差异；采用多因素Logistic回归分析获得ISR的危险因素，以ROC曲线评价各因素诊断ISR的效能。结果 ISR组病变长度，非钙化斑块、点状钙化、正性重构比例和正性重构指数均大于无ISR组（P均<0.05）。多因素Logistic回归分析结果显示，非钙化斑块回归系数（B）=1.89，优势比（OR）=6.63，P=0.01]、点状钙化（B=1.28，OR=3.59，P=0.01）、正性重构（B=2.17，OR=8.71，P<0.01）、病变长度（B=0.05，OR=1.05，P=0.04）是导致ISR的危险因素。病变长度及正性重构指数诊断ISR的ROC曲线下面积（AUC）分别为0.70和0.82（P均<0.01），联合上述斑块特征预判ISR的AUC为0.87（P<0.01）。结论 病变长度、正性重构、非钙化斑块、点状钙化可用于评估冠状动脉支架植入后发生ISR的风险。

CTA features of coronary plaques in evaluation on risk of in-stent restenosis

Objective To evaluate the risk of in-stent restenosis (ISR) after coronary artery stenting according to features of plaques on coronary artery CTA. Methods Totally 166 patients underwent coronary artery CTA before and 6-18 months after stent placement. Then the patients were divided into ISR group (n=16) and non-ISR group (n=150). The stenosis degree and plaque features were observed and compared between the two groups. Multivariate Logistic regression analysis was performed to evaluate ISR risk factors, and ROC curve was used to evaluate the diagnostic efficacy of plaques features in prejudgement of ISR. Results The lesion length, the ratio of noncalcified plaque, spotty calcium, positive remodeling and positive remodeling index in ISR group were higher than those in non-ISR group (all P<0.05). Multivariate Logistic regression analysis showed that noncalcified plaque (B=1.89, odd rateOR]=6.63, P=0.01), spotty calcium (B=1.28, OR=3.59, P=0.01), positive remodeling (B=2.17, OR=8.71, P<0.01) and lesion length (B=0.05, OR=1.05, P=0.04) were the risk factors of ISR. The area under the ROC curve (AUC) of lesion length and positive remodeling index for diagnosing ISR was 0.70 and 0.82 (both P<0.01), respectively. The AUC of the combination of above plaque features for prejudgement of ISR was 0.87 (P<0.01). Conclusion Lesion length, positive remodeling, noncalcified plaque and spotty calcium can be used to evaluate ISR after coronary artery stent placement.