首选冠状动脉CT评估可提高冠心病再血管化的准确性

Increase of correctness in revascularization of coronary artery disease by first assessment of coronary computed tomography angiography

目的探讨冠状动脉（冠脉）CT（CCTA）引导对冠心病再血管化准确性的影响。方法采用回顾性研究方法，连续选择2008年至2009年解放军总医院先行CCTA后行冠脉造影（CAG）的605例患者（CCTA后CAG组），同期选择未进行CCTA直接行CAG的616例患者（直接CAG组）；比较两组治疗策略选择的比例，包括经皮冠脉介入治疗（PCI）、冠脉旁路移植术（CABG）、药物治疗策略、CAG的正常率和再血管化的准确性。结果基线资料显示，CCTA后CAG组患者病变程度（Syntax积分）略高于直接CAG组〔（11.31±8.90）分比（10.23±9.73）分，P＜0.05〕。与直接CAG组比较，CCTA后CAG组行PCI、CABG的比例明显增加〔PCI：65.3%（395/605）比57.1%（352/616），CABG：16.5%（100/605）比3.4%（21/616）〕，药物治疗和CAG正常率明显减少〔药物治疗：11.7%（71/605）比19.3%（119/616），CAG正常率：6.4%（39/605）比20.1%（124/616）〕，再血管化的准确性明显增加〔81.8%（495/605）比60.6%（373/616），均P＜0.01〕。结论与CAG引导相比，CCTA引导下可以提高冠心病再血管化的准确性。

Objective To discuss the influence of coronary computed tomography angiography（CCTA）on correctness of assessing revascularization in patients with coronary artery disease. Methods A retrospective study method was conducted,605 cases underwent CCTA before coronary angiography（CAG）from 2008 to 2009 in Chinese PLA General Hospital were selected as CCTA before CAG group,and meanwhile 616 cases examined by CAG directly were selected as direct CAG group. Patients with multiple procedures of CAG were excluded. The proportions of various treatment strategies were compared,including per-cutaneous coronary intervention（PCI）,coronary artery bypass grafting（CABG）,medical therapy（MT）,normal rate of CAG and the correctness of assessing revascularization between the two groups. Results The comparison between the baseline of the two groups showed that in the CCTA before CAG group,there were more severe lesions than those in the direct CAG group,such as Syntax score（11.31±8.90 vs. 10.23±9.73,P〈0.05）. Compared with direct CAG group,the triage of PCI and CABG in the CCTA before CAG group was significantly increased〔PCI：65.3%（395/605）vs. 57.1%（352/616）,CABG：16.5%（100/605）vs. 3.4%（21/616）〕,while the percentages of medical treatment and normal CAG were obviously reduced〔medical treatment：11.7%（71/605）vs. 19.3%（119/616）,normal rate of CAG：6.4%（39/605）vs. 20.1%（124/616）,all P〈0.01〕. With the guidance of CCTA,the correctness of assessing revascularization was increased〔81.8%（495/605）vs. 60.6%（373/616）,P〈0.01〕. Conclusion Compared with the direct induction by CAG,the CCTA examination carried out before CAG is capable of increasing the rate of correctness in the determination of revascularization in coronary heart diseases.