QCA法评估冠状动脉钙化病变需行冠状动脉旋磨术的预测因素研究

Study on predictive factors of rotational atherectomy for coronary calcified lesions by QCA

目的 通过量化冠状动脉造影(quantitative coronary angiography,QCA)评估钙化病变,探究冠状动脉钙化病变需行冠状动脉旋磨预处理的相关因素。方法 回顾性收集2017年1月至2018年8月于辽宁省人民医院行冠状动脉造影提示存在2~4级钙化病变且行介入治疗患者103例,根据治疗方式不同分为常规治疗组及被动旋磨组。通过QCA方法(西门子影像分析系统)比较两组冠状动脉钙化病变的相关影像学指标的差异。结果 旋磨组与常规治疗组病变在狭窄直径,狭窄程度,钙化厚度,内膜钙化等方面比较存在统计学差异, P 均< 0.05。Logistic回归模型分析提示狭窄程度及内膜钙化是冠状动脉钙化病变需行旋磨术干预的危险因素, P 值分别为0.001及0.027,OR值分别为1.11(95% CI 1.04-1.18)及0.25(95% CI 0.07-0.85)。对狭窄程度指标进行ROC曲线分析提示曲线下区域面积0.76(95%CI 0.66-0.81)。结论 QCA在冠状动脉钙化病变是否行旋磨术中具有预测和指导价值。冠状动脉钙化病变的狭窄程度与内膜钙化是该病变需行冠状动脉旋磨术预处理的相关因素。

Objective Rotational atherectomy (RA) is an effective way for the treatment of coronary calcified lesions. Currently, there are no unified standards of coronary angiography (CAG) to guide Rotational Atherectomy (RA). This study aims for quantitative assessment of calcified lesions through Quantitative Coronary Angiography (QCA) and to explore the risk factors indicated for the treatment of coronary calcified lesions by Rotational Atherectomy (RA). Methods A retrospective study of 103 patients with level 2-4 calcified lesions and interventional therapy in our hospital from January 2017 to August 2018 was performed. According to the treatment methods, the patients were divided into conventional treatment group and passive atherectomy group. By using the QCA method (Siemens Imaging Analysis System), the correlative imaging indexes of coronary calcified lesions were compared between the two groups. Results The calcified lesions in the atherectomy group were statistically different ( P< 0.05) from the conventionally treated lesions in stenosis diameter, stenosis degree, calcification thickness and intimal calcification. Logistic regression analysis revealed that the degree of stenosis and intimal calcification were risk factors for atherectomy in coronary calcified lesions ( P= 0.001 and P= 0.027, respectively). OR values were 1.11 (95% CI 1.04 -1.18) and 0.25 (95% CI 0.07-0.85). ROC curve analysis of the stenosis index indicated that the area under ROC curve was 0.76 (95% CI 0.66-0.81). Conclusion The stenosis degree of coronary calcified lesions and intimal calcification are important risk factors indicated for Rotational Atherectomy (RA).