64层螺旋CT冠状动脉成像评价可疑冠心病患者预后

Prognostic value of 64-slice CT coronary angiography in patients with suspected coronary artery disease

目的探讨64层螺旋CT冠状动脉成像（64-CTCA）判断可疑冠心病患者预后的价值。方法收集1092例接受64-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 39例患者失访,14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。764例检查正常者中,1例死亡,4例发生心脏事件;174例冠状动脉狭窄〈50%患者中,7例发生心脏事件;101例冠状动脉狭窄≥50%患者中,4例死亡,62例发生心脏事件;三者年事件发生率分别为0.65%,4.02%和65.35%。冠状动脉狭窄程度、狭窄位置及斑块类型均为影响预后的危险因素（HR=14.586,95%CI=8.751~24.313;HR=2.624,95%CI=2.275~3.027;HR=1.648,95%CI=1.204~2.257;P均〈0.001）。结论 64-CTCA能够为可疑冠心病患者提供预后参考信息,64-CTCA检查正常者预后较好。

Objective To assess the prognostic value of 64-slice CT coronary angiography（64-CTCA） in patients with suspected coronary artery disease（CAD）.Methods Totally 1092 consecutive patients with suspected CAD underwent 64-CTCA.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 39 patients were lost during follow-up,and 14 were excluded as a result of low quality images.During the follow-up of（22.74±7.27） months,1 patient died and 4 had cardiac events in 764 patient with normal 64-CTCA results,7 had severe cardiac events in 174 patients of coronary stenosis 50%,and 62 had severe cardiac events in 101 patients of coronary stenosis ≥50%.The rate of cardiac events was 0.65%,4.02% and 65.35%,respectively.The extent of stenosis,locations and components of plaques were recognized as risk factors of cardiac events（HR=14.586,95%CI=8.751—24.313;HR=2.624,95%CI=2.275—3.027;HR=1.648,95%CI=1.204—2.257;all P0.001）.Conclusion To patients with suspected CAD,64-CTCA has significant prognostic impact on the prediction of cardiac events.Normal CAD results identify good prognosis.