冠脉CT对冠心病治疗策略的影响

Impact of coronary computed tomography angiography on patient triage strategies

目的冠脉CT（CCTA）的准确性已经得到证实，但其临床应用的情况目前尚没有统计资料。方法采用回顾性的队列研究方法，连续收集2008年3月3日-2009年6月23日在解放军总医院行CCTA检查的患者，统计其后治疗取向，包括是否进行了CAG，经皮冠状动脉介入治疗（PCI），冠状动脉旁路手术（cABG），药物治疗和正常CAG，并与同期进行的直接CAG进行比较。结果从2008年3月3日-2009年6月23日共行CCTA检查8030例，直接CAG3260例。CCTA组的危险因素明显低于CAG组，差异有统计学意义（P〈0．0001）。大多数患者CCTA后没有进一步行CAG，占87．97％。CCTA后CAG953例，其中CAG正常3．7％，药物治疗11．3％，PCI63．4％，CABG21．6％。直接CAG组3260例，其中CAG正常17．9％，药物治疗25．1％，PCI52．9％，CABG4．4％。CCTA后CAG和直接CAG组比较，CCTA增加了再血管化治疗率，差异有显著统计学意义（P〈0．0001）。结论经过CCT筛选，再血管化治疗率明显提高，而正常CCTA减少。但目前门诊所做的CCTA阳性率较低，大多数为正常或轻中度病变，需CAG的很少，滥用现象则凸显。

Objective To investigate the triaging pathways of patients after coronary computed tomography angiography （CCTA）. Methods The patients undergoing CCTA were enrolled consecutively during the period from March 3, 2008 to June 23, 2009. The rate of coronary angiography （CAG） examinations after CCTA was calculated. The rates of normal CAG, medication, percutaneous coronary intervention （PCI）, and coronary artery bypass graft （CABG） were compared between CCTA and direct CAG cohorts. Results A total of 8030 cases receiving CCTA and 3260 receiving direct CAG were included in the study. The CCTA patients had significantly fewer risk factors than those having direct CAG. Of the 8030 patients undergoing CCTA, 953 （12.03%） received further CAG and 6977 （87.97%） did not. Of the patients who received CAG after CCTA, 35 （3.7%） had normal CAG findings, 604 （63.4%） underwent PCI, 108 （11.3%） received conservative treatment with medications, and 206 （21.6%） underwent CABG. In the 3260 patients directly undergoing CAG, 706 （52.3%） underwent subsequent PCI, 142（4.4%） underwent CABG, 815（25.1%） received medications, and 579 （17.9%） had normal CAG findings. Comparison between the cases receiving direct CAG and CAG after CCTA showed that CCTA resulted in a significant increase in the revascularization rate （P〈0.0001）. Conclusion CCTA can help prevent unnecessary CAG and allows more accurate patient triage.