冠状动脉粥样硬化斑块特征和管腔重构的320排CT研究

目的探讨320排冠状动脉CT造影（CCTA）斑块特征和血管重构的预后价值。方法经320排CCTA检查的368例冠心病患者被随访18～28个月，平均（23±5.5）个月。研究终点是发生冠状动脉不良事件（心源性猝死、非致命性心肌梗死和不稳定型心绞痛）。 CCTA分析包括钙化斑块（CP）、非钙化斑块（NCP）和混合斑块（MP）、梗阻性斑块、正性重构（PR）、偏心性斑块。通过手工测量血管横截面积定义重构指数（RI），RI＝病变处血管横截面积/（病变处近端正常血管面积＋远端血管面积）/2。 RI＞1.10为PR， RI＜0.95为负性重构（NR）。 RI＝0.95～1.10为无重构。结果368例1231个节段被发现存在动脉斑块，包括CP 155个节段（12.6％）、NCP 543个节段（44.1％）、MP 533个节段（43.3％）、梗阻性斑块188个节段（15.3％）、PR 145个节段（11.8％）、偏心性斑块1033个（83.9％）。随访期间，21例（5.6％）发生冠状动脉不良事件。单因素分析显示MP，与未并发冠状动脉不良事件斑块比较，梗阻性斑块、PR、偏心性斑块发生冠状动脉不良事件发病率高（分别是74.9％ vs．42.8％， P＝0.021；95.2％ vs．13.9％， P＜0.001；95.2％ vs．10.3％，P＜0.001；95.2％ vs．83.7％，P＝0.043）。多因素Cox比例风险回归模型分析显示仅梗阻性斑块[HR＝5.25（95％CI，2.17～12.69），P＜0.001]和PR[HR＝5.55（95％ CI，2.10～14.70），P＜0.001]是发生冠状动脉不良事件的独立预测因素。结论 CCTA表现为梗阻性斑块和PR，独立于其他CCTA高危因素，强烈暗示将来发生冠状动脉不良事件。

Coronary atherosclerotic plaque characteristics and vascular remodeling on 320-raw coronary computed tomography angiography

Objective To determine the predictive value of coronary atherosclerotic plaque characteristics and vascular remodeling on 320-raw coronary computed tomography angiography （ CCTA） for adverse coronary events in patients with coronary artery diseases .Methods The 368 consecutive patients with coronary artery diseases who underwent 320-raw CCTA examination and were followed for 18-28（23 ±5.5）month.The study endpoint was an adverse coronary event （ cardiac death , nonfatal myocardial infarction , or unstable angina pectoris ） .The CCTA analysis included the presence of calcified plaque （CP）,non-calcified plaque（NCP）,mixed plaque（MP）,obstructive plaque,positive remodeling（PR）,and eccentricity plaque.The manual inspection was used to define the remodeling index（ RI） in the axial cross section area .RI=the axial cross section area at the plaque site/the axial cross section area proximal to the plaque site in a normal-appearing vessel segment ＋the axial cross section area distal to the plaque site in a normal-appearing vessel segment/2.The PR was defined by a RI 〉1.10,the NR was defined by a RI〈0.95,and non-remodeling was defined by a RI =0.95-1.10.Results Of the 368 patients,the 1231 plaques were observed,including plaques with CP in 155（12.6%）,with NCP in 543（44.1%）,with MP in 533（43.3%）, with obstructive plaque in 188 （ 15.3%） , with PR in 145 （ 11.8%） , with eccentricity plaque in 1033 （ 83.9%） . During the follow-up period , 21 patients （ 5.6%） experienced ACS events .Segment-based single factor analysis showed that MP ,obstructive plaque ,PR,and eccentricity plaque had a higher prevalence with adverse coronary event as compared without adverse coronary event （74.9% vs.42.8%,P=0.021,95.2% vs.13.9%,P〈0.001,95.2%vs.10.3%,P〈0.001,95.2%vs.83.7%,P=0.043,respectively）.Segment-based Cox proportional hazards models＆amp;nbsp;analysis showed that only obstructive plaque [HR=5.25（95% CI,2.17-12.69）,P〈0.001]and PR[HR=5.55 （95% CI, 2.10-14.70 ）, P 〈0.001 ] were independent predictive factors for future adverse coronary event . Conclusion The present study demonstrated that the obstructive plaque and PR demonstrated on CCTA was strongly associated with future adverse coronary events ,independent of other high-risk CCTA features .