高危斑块对冠状动脉轻中度狭窄胸痛患者的预测价值

The predictive value of high-risk plaque in patients with chest pain and mild-to-moderate stenosis of coronary artery

目的:评价高危斑块对冠状动脉(冠脉)轻中度狭窄胸痛患者的预测价值。方法:连续入选2014-01-2015-12因胸痛来我院行冠脉CT血管造影(CCTA)提示冠脉轻中度狭窄患者384例,入选患者通过CT检查检出低CT衰减、餐巾环征、正性重构、点状钙化等特征的高危斑块。患者根据高危斑块积分分为3组,0分组292例,1分组30例,≥2分组62例。第1、3、6及12个月时对入选患者进行随访,记录主要不良心脏事件(MACE)。结果:随访期间共发生76例心脏不良事件。总体不良事件及心源性死亡方面,≥2分组患者高于0分组(P<0.05)。Kaplan-Meier生存分析表明,0分组、1分组及≥2分组累积无事件生存率分别为83.2%、78.1%及60.0%,0分组显著高于≥2分组(χ~2=16.29,P<0.05)。COX回归分析表明,高危斑块积分≥2分对患者预后有显著影响(HR=3.447,95%CI:2.112~5.625,P<0.01)。结论:高危斑块是冠脉轻中度狭窄胸痛患者发生心脏不良事件的独立危险因素,尤其高危斑块积分≥2分与患者预后显著相关,高危斑块积分可尝试评价胸痛患者预后。

Objective：To evaluate the predictive value of high-risk plaques in patients with chest pain and mildto-moderate stenosis of coronary artery.Method：A total of 384 patients examined by coronary computer tomography angiography（CCTA）with mild-to-moderate stenosis of coronary artery because of chest pain at Tianjin Chest Hospital were recruited from January 2014 to December 2015.The morphological characteristics of coronary artery plaques in the subjects were detected by CCTA,including the low CT attenuation,napkin-ring sign,positive reconstruction,punctate calcification and so on.According to the principle that a high-risk characteristic plaque accumulated 1 point,we divided the subjects into three groups,0-point group（n=292）,1-point group（n=30）and≥2-point group（n=62）.By a total of four times phone or outpatient follow-up at 1 month,3 months,6 months and 12 months,we recorded the adverse cardiac events（MACE）.Result：A total of 76 cases of adverse cardiac events occurred during the follow-up period.Overall,according to the incidence of adverse cardiac events and cardiac death,the≥2-point group was higher than the 0-point group（P〈0.05）.Kaplan-Meier survival analysis showed that the survival rate of non-accumulated event in the 0-point group,1-point group and ≥2-point group were 83.2%,78.1% and 60.0%,respectively,and the 0-point group was significantly higher than the≥2-point group（χ^2=16.29,P〈0.05）.COX regression analysis showed that the patients with high-risk plaques accumulated points≥2 had a significant impact on the prognosis（HR=3.447,95%CI=2.112-5.625,P〈0.01）.Conclusion：High-risk plaque is an independent risk factor for the incidence of adverse cardiac events in patients with chest pain and mild-to-moderate stenosis of coronary artery.Especially,high-risk plaque has a significant correlation with the prognosis.We can attempt to evaluate the prognosis of patients with chest pain by accumulated points of high-risk plaques.