运动平板试验结合多排冠状动脉螺旋CT血管造影对疑似冠心病患者的预测价值

Prognostic value of multidetector coronary computed tomography angiography combined with treadmill exercise test in patients with suspected coronary artery disease

目的：探讨运动平板试验（TET）结合多排螺旋CT血管造影（CTA）对冠状动脉病变预后的预测价值。方法回顾性分析595例行冠状动脉CTA和TET检查的疑似冠心病患者的资料。冠状动脉CTA分为正常、轻度狭窄（＜40%）、中度狭窄（40%~69%）、严重狭窄（＞70%）；TET结果分为阳性和阴性，并计算DUKE积分，记录随访1.52~3.31年的主要心血管事件（MACE）。结果记录到39次MACE，发生率为2.74%，冠状动脉CTA能有助于危险分层，TET结合冠状动脉CTA与单独冠状动脉CTA比较并不能提高危险分层（P＞0.05）。CTA中度和重度狭窄者、TET阳性对预测MACE有价值，HR分别为2.60（95%CI 1.31~5.22，P＜0.01）和2.35（95%CI 1.22~4.83，P＜0.05）。结论 TET阳性对冠状动脉CTA中、重度狭窄者有预后预测价值。

Objective To evaluate the value of multidetector coronary computed tomography angiography（CTA） combined with treadmil exercise test （TET） in predicting prognosis of coronary artery lesion. Methods The data of 595 patients with suspected coronary artery disease underwent both coronary CTA and TET were analyzed retrospectively. Coronary CTA results were classified to normal, mild stenosis（〈40%of luminal stenosis）, moderate stenosis（40%to 69%）, and severe stenosis （〉70%）. TET results were categorized as positive and negative. Duke TET score was calculated. Major adverse cardiac events （MACE） during fol ow- up 1.52 to 3.31 years were recorded. Results 39 MACE were observed and 3- year cumulative event rate was 2.74%. Coronary CTA improved risk stratification. TET combined with coronary CTA was not superior to coronary CTA alone in risk categorization. In patients with moderate and severe coronary stenosis on coronary CTA, positive TET predicted MACE with HR 2.6 （95%CI：1.31~5.22, P〈0.01） and HR 2.35（ 95%CI：1.22~4.83, P〈0.05）, respectively. Conclusion Positive TET is predictive for prognosis in patients with moderate to severe stenosis on coronary CTA.