冠状动脉CT造影狭窄程度预测患者远期预后的临床价值研究

Long-term Prognostic Value of Coronary Stenosis Detected by Coronary CT Angiography

背景冠状动脉CT造影(CCTA)是无创性评价冠状动脉狭窄的方法,但其对患者远期预后的预测价值国内少有报道。目的评估CCTA狭窄程度预测患者远期预后的临床价值。方法本文为回顾性队列研究。连续纳入2012-01-01至2012-09-30在四川大学华西医院住院期间曾行CCTA的患者。依据2016年发布的冠状动脉疾病报告与数据系统(CAD-RADS)对狭窄程度进行评分,依据CAD-RADS评分分为无斑块组、非阻塞性斑块组、阻塞性斑块组。主要终点事件是全因死亡,次要终点事件是心源性死亡、非致死性心肌梗死、择期血运重建。随访于2017-08-01至2017-10-10完成。结果本研究最终纳入705例患者,平均随访(5.0±0.9)年。其中无斑块组295例(41.8%),非阻塞性斑块组410例(58.2%),阻塞性斑块组221例(31.3%)。阻塞性斑块组5年全因死亡率(19.0%)高于无斑块组(5.8%)和非阻塞性斑块组(7.4%)(χ^2=21.88、11.62,P<0.001)。Cox比例风险模型显示,年龄、急性冠脉综合征、阻塞性狭窄(CAD-RADS评分≥3分)是5年全因死亡的影响因素(P<0.05)。阻塞性斑块组5年心源性死亡率(7.7%)高于无斑块组(0.7%)和非阻塞性斑块组(1.6%)(χ^2=17.53、8.18,P<0.001)。Cox比例风险模型显示,急性冠脉综合征、阻塞性狭窄是5年心源性死亡的影响因素(P<0.05)。阻塞性斑块组择期血运重建率(12.7%)高于无斑块组(2.0%)和非阻塞性斑块组(4.8%)(χ^2=23.64、7.76,P<0.001)。阻塞性斑块组5年非致死性心肌梗死率(7.7%)高于无斑块组(1.4%)和非阻塞性斑块组(1.6%)(χ^2=13.18、8.18,P<0.001)。无斑块组和非阻塞性斑块组5年全因死亡率、心源性死亡率、择期血运重建率、非致死性心肌梗死率比较,差异均无统计学意义(P>0.05)。结论经CCTA评估的冠状动脉狭窄程度越重患者长期预后指标较差,阻塞性狭窄是其5年全因死亡、心源性死亡的影响因素。阻塞性斑块患者的全因死亡率、心源性死亡率、非致死性心肌梗死率、择期血运重建率均较非阻塞性斑块与无斑块患者低,非阻塞性斑块患者与无斑块患者的远期预后相当。

Background Coronary CT angiography(CCTA)is a non-invasive method for evaluating coronary artery stenosis,but its long-term prognostic value has rarely been reported in China.Objective To evaluate the clinical value of coronary stenosis detected by CCTA in predicting long-term prognosis of patients.Methods This is a retrospective cohort study.Consecutive inpatients who underwent CCTA in West China Hospital,Sichuan University from January 1,2012 to September 30,2012 were analyzed.In accordance with the stenosis degree was scored by the CAD-RADS introduced in 2016,they were divided into plaque-free group,non-obstructive plaque group and obstructive plaque group.The primary end point was allcause death,and the secondary end points were cardiac death,nonfatal myocardial infarction and elective revascularization.The following up completed from August 1,2017 to October 10,2017.Results The study eventually included 705 patients with an average follow-up of(5.0±0.9)years,including 295(41.8%)without plaque,410(58.2%)with non-obstructive plaques,and 221(31.3%)with obstructive plaques.5-year all-cause mortality(19.0%)in obstructive plaque group was significantly higher than that in plaque-free group(5.8%)and non-obstructive plaque group(7.4%)(χ^2=21.88,11.62,P<0.001).Cox proportional hazard model showed that age,ACS,and obstructive stenosis(CAD-RADS≥3)was a risk factor for 5-year all-cause mortality(P<0.05).The 5-year cardiac mortality in the obstructive plaque group(7.7%)was significantly higher than that in the plaque-free group(0.7%)and non-obstructive plaque group(1.6%)(χ^2=17.53,8.18,P<0.001).Cox proportional risk model showed that age,acute coronary syndrome,and obstructive stenosis(cad-rads score≥)were the influencing factors of 5-year cardiac death(P<0.05).The 5-year selective revascularization rate in the obstructive plaque group(12.7%)was significantly higher than that in the plaque-free group(2.0%)and the non-obstructive plaque group(4.8%)(χ^2=23.64,7.76,P<0.001).The 5-year non-fatal myocardial infarction rate in the obstructive plaque group(7.7%)was higher than that in the plaque-free group(1.4%)and the non-obstructive plaque group(1.6%)(χ^2=13.18,8.18,P<0.001).There were no significant differences in 5-year all-cause death,cardiac death,selective revascularization,and non-fatal myocardial infarction rate between the non-obstructive plaque group and the plaque-free group(P>0.05).Conclusion The longer-term prognosis of patients with severe coronary artery stenosis assessed by CCTA was worse,whose 5-year allcause mortality,and cardiac mortality were associated with obstructive plaques.Compared with those with non-obstructive plaques or without plaques,patients with obstructive plaques had lower all-cause mortality,cardiac mortality,non-fatal myocardial infarction rate and selective revascularization rate.The long-term prognosis was similar between those with non-obstructive plaques and those without plaques.