急性与慢性冠状动脉综合征患者电子束CT冠状动脉钙化的比较

The different patterns of coronary artery calcification in acute and chronic coronary syndromes determined by electron beam computed tomography

目的 比较急性与慢性冠状动脉综合征患者电子束CT(EBCT)冠状动脉钙化(CAC)的不同模式。方法264例患者(包括67例SAP、94例UAP和103例AMI)行选择性冠状动脉造影以检测粥样硬化狭窄的程度,行EBCT检查以计算CAC积分,分析各组患者CAC积分的差异及其与狭窄程度的关系。结果 ①SAP组CAC检测阳性率为100％,显著高于UAP组的87.23％和AMI组的86.41％(P<0.05)。②SAP组严重钙化的病人和动脉比例者显著高于UAP组和AMI组(P<0.05),钙化积分自然对数转换值(In[CS+1])的均数SAP组显著高于UAP组和AMI组(P<0.001)。③不同CAC程度在不同狭窄冠状动脉上的分布在SAP组与UAP组有明显差异。④AMI组梗死相关动脉多数无钙化或仅有轻度钙化,钙化积分显著低于非梗死相关动脉。结论 应用电子束CT研究显示,急性与慢性冠状动脉综合征患者存在不同的冠状动脉钙化模式,此点有助于理解这两类冠心病之间在临床和病理方面的差异。

Objectives To compare the different patterns of coronary artery calcification (CAC) in acute and chronic coronary syndromes utilizing electron beam computed tomography. Methods Two hundred and sixty-four patients, including 67 with stable angina pectoris (SAP), 94 with unstable angina pectoris (UAP) and 103 with acute myocardial infarction (AMI) were studied with electron beam computed tomography for analysis of coronary artery calcification and with selective coronary angiography for determination of atherosclerotic lesions. CAC prevalence and calcium score were compared among three groups, and relation of CAC to the severity of atherosclerotic disease in the SAP and UAP patients was separately analyzed. Results Prevalence of CAC was 100% in the SAP patients, significantly ingher than the 87.23 % in UAP patients and 86.41% among the patients with AMI (P < 0.05) . More patients and arteries in the SAP group had severe forms of calcium than those in the UAP and AMI group (P < 0.01), and the mean ln[CS+l] (natural logarithm transformation of calcium score) of the SAP patients was much greater than that of the UAP and AMI patients (P < 0.001), The distribution of vessels with various CAC by luminal stenosis was different between SAP and UAP patients. The average CAC extent of the infarct-related arteries was less severe than that of the noninfarct-related arteries. Conclusions Utilizing electron beam computed tomography, we demonstrate that there exist different patterns of coronary artery calcification in patients with acute versus chronic coronary syndromes, winch may provide insight into the differences observed in the clinical and pathologic development between these two types of coronary artery disease.