冠脉CTA评估慢性完全闭塞型病变患者介入疗效的预测价值

Predictive value of coronary CTA in evaluating the interventional efficacy of patients with chronic total occlusion

目的研究冠状动脉CT血管造影(CTA)对慢性完全闭塞型病变(CTO)患者介入治疗效果的预测价值。方法回顾性分析新乡医学院第一附属医院2015年1月至2018年1月间接受介入术治疗的98例CTO患者介入术前CTA资料,以日本CTO评分(J-CTO)及CT-CTO评分标准对术前CTA资料进行评估,根据评估结果预测介入治疗能否成功,以介入术实际疗效为金标准;分析术前CTA预测结果与金标准间的一致性,计算各项CTA预测效能指标;根据金标准将入选患者分为成功组与失败组,对比两组CTA指标。结果成功组和失败组患者的J-CTO[(11.86±2.15)分vs(15.31±1.40)分]、CT-CTO[(8.43±2.35)分vs(10.78±1.05)分]、闭塞长度[(16.73±4.97)mm vs(26.96±6.04)mm]、钙化程度[(126.02±50.29)vs(153.27±43.61)]比较,成功组明显少于或短于失败组,差异均有统计学意义(P<0.05);冠脉CTA预测CTO患者介入术结果与金标准间具有高度一致性(0.8<Kappa≤1.0,P<0.05);冠脉CTA预测CTO患者介入术结果准确率为93.88%。结论冠脉CTA应用于介入术前评估介入术疗效具有较高的预测价值,对于介入术式的选择及术后后续治疗等均具有重要的指导意义。

Objective To study the predictive value of coronary angiography(CTA)for interventional treatment of patients with chronic total occlusion(CTO).Methods A retrospective analysis was performed on 98 patients with CTO underwent coronary angiography in the First Affiliated Hospital of Xinxiang Medical College from January 2015 to January 2018.Japanese CTO score(J-CTO)and computed tomography(CT)were used as CTO criteria to evaluate preoperative CTA,and the success of interventional therapy was predicted according to the evaluation results,taking the actual effect of interventional therapy as gold standard;the consistency between the preoperative CTA prediction results and the gold standard was analyzed,and the performance indicators of CTA prediction were calculated.According to the gold standard,the selected patients were divided into the successful group and the failed group,and the CTA indicators of the two groups were compared.Results The J-CTO,CT-CTO,occlusion length,and calcification degree in the successful group were(11.86±2.15)points,(8.43±2.35)points,(16.73±4.97)mm,126.02±50.29,which were significantly lower or shorter than corresponding(15.31±1.40)points,(10.78±1.05)points,(26.96±6.04)mm,153.27±43.61 in the failed group(all P<0.05);there was a high consistency between the results of coronary CTA in predicting CTO patients and the gold standard(0.8<Kappa≤1.0,P<0.05);the accuracy rate of CTA prediction in CTO patients was 93.88%.Conclusion Coronary CTA has a high preoperative predictive value in evaluating the curative effect of interventional surgery,and it has an important guiding significance for the selection of interventional surgery and postoperative follow-up treatment.