冠状动脉CT对疑似冠心病患者长期心血管事件预测价值的研究

目的 探讨螺旋CT冠状动脉成像（CTCA）判断可疑冠心病患者长期预后的价值.方法 收集2010年1月至2012年12月534例接受CTCA检查的患者,分析其CTA结果,评估影响患者预后的危险因素.随访终点事件包括心源性死亡、心肌梗死、不稳定型心绞痛以及住院接受经皮冠状动脉介入治疗（PCI）、冠状动脉搭桥术（CABG）、溶栓治疗.结果 15例患者失访,8例患者因图像质量较差、不能用于评价而被排除.平均随访（22.74±7.27）个月.180例检查正常者中,1例死亡,213例冠状动脉狭窄〈50%患者中,3例发生心脏事件;124例冠状动脉狭窄≥50%患者中39例发生心脏事件.在众多因素分析中,糖尿病、高血压病、吸烟以及CTCA显示的冠状动脉斑块为心血管病事件的预测因素.CTCA显示的冠状动脉斑块与心血管病事件密切相关（风险比为5.23,95%可信区间：2.35-11 88）.结论 CTCA显示的冠状动脉斑块能够为临床提供有关可疑冠心病患者预后的信息,为心血管事件的独立预测因素,能为患者的危险分层提供有用的价值.

Coronary Tomography for Predicting Long-Term Cardiovascular Events in Patients with Suspected Coronary Disease

Objective Determine the value of MDCT in predicting Coronary Events in patients with suspected CAD. Methods We prospectively evaluated 534consecutive patients （mean age 59 ± 11 years, 452 males） with suspected CAD between January 2010 and December 2012. The results were analyzed and risk factors impacting prognosis were evaluated. Patients were followed up for the occurrence of cardiac death,nonfatal myocardial infarction,unstable angina and requiring hospitalization. Results A total of 15 patients were lost during follow-upo and 8 were excluded as a result of low quality images. During a mean follow-up of 25months, there were 43 cardiac events. Results. 1 patient died in 180 patient with normal CTCA results,3 had severecardiac events in 213 patients of coronary stenosis〈50% ,and 39 had severe cardiac events in 124 patients of coronary stenosis≥50 % In the multivariate analysis using the CoX regression model, diabetes, smoking, hypertension and atherosclerosis at the MDCT were predictors of adverse clinical out- come, and the presence of plaque at the MDCT was strongly associated with adverse clinical outcomes, regardless of established risk factors for CAD （hazard ratio 5.23% 95 % confidence interval： 2.35 -11.8, P〈0. 001）. Conclusion ＇The presence of atherosclerosis demonstrated by MDCT in patients With suspected CAD showedindependent and incremental value when compared tO conventional risk factors in the prediction of adverse clinical Outcomes, and may prove useful in risk stratification of these patients.