钙化积分对冠状动脉介入治疗的稳定性冠心病患者的预测价值

Prognostic value of coronary artery calcium score in stable angina pectoris patients underwent percutaneous coronary intervention

目的探讨冠状动脉钙化积分(CCS)对稳定性冠心病患者经皮冠状动脉介入治疗(PCI)后近、远期预后的预测价值。方法 109例稳定性心绞痛患者在首次PCI治疗前均接受冠状动脉CT检查,计算CCS;对患者进行长期随访,记录有无死亡、非致死性心肌梗死、靶病变血运重建以及再发心绞痛入院等主要心脏事件(MACE)发生。结果 CCS与患者年龄呈正相关(r=0.42,P=0.000),男性患者和糖尿病患者中CCS明显高于女性患者(590.8±764.5比352.8±336.3,t=2.25,P=0.026)和非糖尿病患者(693.3±912.4比413.0±464.1,t=2.11,P=0.037)。平均随访15个月(3～40个月),Kaplan-Meier生存分析发现CCS≤300,CCS301～1000和CCS>1000的患者累积无事件生存率差异有统计学意义(88.2%比81.6%比62.5%,Logrank7.49,P=0.024)。校正了年龄、性别、体重指数、糖尿病、高脂血症、多支病变、是否完全血运重建及PCI并发症后,多因素Cox回归分析显示CCS>1000的患者发生MACE的风险较CCS≤300的患者增加3.44倍(HR=3.44,P=0.043)。结论 CCS是预测稳定性冠心病患者PCI治疗后发生主要心脏事件的独立危险因子,对慢性稳定性冠心病患者的预后评价具有重要意义。

Objective To evaluate whether coronary artery calcium score（CCS）is an independent prognostic factor in stable angina pectoris patients underwent percutaneous coronary intervention（PCI）.Methods One hundred and nine stable angina pectoris patients underwent first PCI were enrolled and followed up.Electron-beam computed tomography（EBCT）was examined in all patients before PCI and CCS was calculated.Main adverse cardiac events（MACE）were defined as a combined end point of death,non-fatal myocardial infarction,target lesion revascularization and rehospitalization for cardiac ischemic events.Results CCS was positively correlated with age（r=0.42,P=0.000）.It was higher in male patients and diabetes mellitus patients when compared with female patients and non-diabetes mellitus patients.After average 15.0 months（3-40 months）of follow-up,Kaplan-Meier survival analysis showed the patients with CCS≤300,CCS 301~1000 and CCS1000 had significantly different cumulative non-events survival rates（88.2% vs 81.6% vs 62.5%,Log rank 7.49,P=0.024）.Adjusted for other confounders,multivariate Cox regression analysis showed the risk of occurrences of MACE increased 3.44 folds in the patients with CCS1000 compared with the patients with CCS≤300（HR=3.44,P=0.043）.Conclusion CCS is an independent predictor of long-term occurrences of MACE in stable angina pectoris patients treated with PCI.