钙化积分在复杂冠心病血运重建决策中的应用

Application of calcification scores in decision of revascularization for complex coronary heart disease

目的探讨冠状动脉钙化积分(CACS)在复杂冠心病不同血运重建疗法之间的差异性。方法选取2017年10月至2018年11月国药东风总医院收治的被诊断为冠状动脉三支和(或)左主干病变的复杂冠心病患者,共计98例,均接受血运重建治疗,根据不同血运重建方式分为冠状动脉旁路移植术(CABG)组和经皮冠状动脉介入治疗(PCI)组,两组患者术前均进行CACS检查,计算各血管分支CACS、总CACS、重度狭窄节段CACS,分析两组患者之间的差异。结果CABG组患者左前降支(LAD)、左回旋支(LCX)、右冠状动脉(RCA)、总CACS及重度狭窄节段CACS明显高于PCI组,差异有统计学意义(P<0.01),两组患者仅左主干(LM)CACS差异无统计学意义(P>0.05)。结论利用冠状动脉CT血管造影(CCTA)测量CACS,可辅助临床决策复杂冠心病患者血运重建方案的选择、术前器械准备以及风险和疗效评估。

Objective To investigate the difference of coronary artery calcification score (CACS) in different revascularization therapies for complex coronary heart disease. Methods According to the different therapies of coronary revascularization (CRV) 98 patients with complex coronary heart disease diagnosed as three-vessel and/or left main coronary artery lesions receiving the revascularization therapies in this hospital from October 2017 to November 2018 were selected and divided into coronary artery bypass grafting (CABG) group and percutaneous coronary intervention (PCI) group.Both groups received the CACS examination before operation.The scores of each coronary artery branch,total calcification integral,calcification scores of severe stenosis segment were calculated,and the difference between the two groups was analyzed. Results The scores of left anterior descending artery (LAD),left circumflex artery (LCX),right coronary artery (RCA),total calcification score and calcification scores of severe stenosis segment in the CABG group were significantly higher than those in the PCI group,and the differences were statistically significant ( P <0.01).There was no statistically significant difference only in the calcification score of left main artery (LM) between the two groups( P > 0.05). Conclusion Measuring CACS by using the coronary CT angiography (CCTA) can assist in the clinical decision of revascularization scheme selection in the patients with complex coronary heart disease,preoperative apparatus preparation,and evaluation of risk and curative effect.