CTA在急性冠脉综合征介入治疗患者术前及术后随访中的应用

Application of CTA in Preoperative and Postoperative Follow-up of Patients with Interventional Therapy of Acute Coronary Syndrome

目的探索CT血管造影(CTA)应用于急性冠脉综合征(ACS)患者介入术治疗前后的临床价值。方法回顾性分析126例行介入术治疗的ACS临床资料,以数字血管减影造影(DSA)为金标准,分析CTA对ACS患者术前血管狭窄程度分级诊断准确性;根据术后6个月内支架内再狭窄(ISR)发生情况分为ISR组(n=22)与对照组(n=104),分析CTA对术后ISR分型诊断准确性,并比较两组CTA定量参数差异。结果126例ACS患者术前经DSA确诊245支病变冠状动脉,CTA对其狭窄程度分级诊断准确率为87.76%(215/245),对术后ISR分型诊断准确率为78.57%(99/126)。术后ISR组CT血流储备分数(FFRCT)、管腔内密度衰减梯度-校正值(TAG-CCO)水平均明显低于对照组,差异均有统计学意义(P<0.05)。结论 CTA能对ACS患者介入治疗术前血管狭窄程度进行准确分级,并在术后随访中对ISR作出早期定性与定量评估,有利于制定合理介入治疗方案并改善患者预后。

Objective To explore the clinical value of CT angiography(CTA)in patients with acute coronary syndrome(ACS)before and after interventional therapy.Methods The clinical data of 126 ACS patients undergoing interventional therapy were retrospectively analyzed.Digital subtraction angiography(DSA)was used as the gold standard to analyze the accuracy of CTA in the grading diagnosis of postoperative vascular stenosis degree in patients with ACS.According to the occurrence of in-stent restenosis(ISR)within 6 months after operation,the patients were divided into ISR group(n=22)and control group(n=104).The accuracy of CTA in the diagnosis of postoperative ISR classification was analyzed,and the CTA quantitative parameters were compared between the two groups.Results Among 126 patients with ACS,245 coronary artery lesions were diagnosed by DSA before operation,and the accuracy of CTA for stenosis degree grading was 87.76%(215/245),and the accuracy for postoperative ISR classification was 78.57%(99/126).The CT fractional flow reserve(FFRCT)and transluminal contrast attenuation gradient-corrected contrast opacification(TAG-CCO)in ISR group after operation were significantly lower than those in control group(P<0.05).Conclusion CTA can accurately classify the vascular stenosis degree before interventional therapy for ACS patients,and make early qualitative and quantitative evaluation for ISR during postoperative followup,and it is conducive to the development of reasonable interventional therapy and the improvement of prognosis.