冠脉CTA检查在中低危的NSTEMI患者评估中的应用价值

Application value of coronary CT angiography in the evaluation of low-and moderate-risk patients with non-ST-segment elevation myocardial infarction

目的探讨冠脉CT血管造影(CTA)检查在中低危的非ST段抬高型心肌梗死(NSTEMI)患者评估中的应用价值。方法选择2019年8月至2020年8月于延安大学咸阳医院诊治的154例中低危NSTEMI患者为研究对象,根据随机单双数法分为对照组和研究组各77例。对照组患者均安排行侵入性冠状动脉造影(ICA)检查,研究组患者先行冠脉CTA检查,如果检查结果显示冠状动脉重度及以上狭窄,则安排行ICA检查。比较两组患者的住院时间、住院费用、医院焦虑抑郁量表(HADS)评分、ICA阳性率;随访1年,比较两组患者的主要心血管事件(MACE)及其他严重不良事件。结果研究组患者的住院时间、住院费用及HADS评分分别为(3.74±1.05)d、(24522.45±7839.68)元、(8.76±2.65)分,明显少(低)于对照组的(4.88±1.54)d、(27321.27±8965.13)元、(11.52±3.12)分,差异均有统计学意义(P<0.05);研究组共有56例患者行ICA检查,ICA阳性率为94.64%(53/56),明显高于对照组的62.34%(48/77),差异有统计学意义(P<0.05);随访1年,两组患者的MACE及其他严重不良事件发生率比较差异均无统计学意义(P>0.05)。结论冠脉CTA检查在评估中低危NSTEMI患者需不需要行ICA检查的价值较高,能显著减少ICA检查的数量,并有效提高ICA阳性率,从而缩短患者住院时间,减少住院费用,改善其焦虑、抑郁心态。

Objective To evaluate the value of coronary CT angiography(CTA)in the evaluation of patients with low-and moderate-risk non-ST-segment elevation myocardial infarction(NSTEMI).Methods A total of 154 patients with moderate-and low-risk NSTEMI admitted to Xianyang Hospital of Yan’an University from August 2019 to August 2020 were selected as the study subjects.According to the random odd and even number method,the patients were divided into a control group and a study group,each with 77 patients.All patients in the control group were arranged for invasive coronary angiography(ICA)examination.Patients in the study group underwent coronary CTA examination first,and if the results showed severe coronary artery stenosis or above,ICA examination was arranged.The hospitalization time,hospitalization cost,Hospital Anxiety and Depression Scale(HADS)score,and ICA positive rate were compared between the two groups.The patients were followed up for 1 year to compare the main cardiovascular events(MACE)and other serious adverse events between the two groups.Results The length of hospital stay,hospitalization cost,and HADS score of patients in the study group were(3.74±1.05)d,(24522.45±7839.68)yuan,(8.76±2.65)points,which were significantly less(lower)than(4.88±1.54)d,(27321.27±8965.13)yuan,(11.52±3.12)points in the control group(P<0.05).A total of 56 patients in the study group underwent ICA examination,and the positive rate of ICA was94.64%(53/56),which was significantly higher than 62.34%(48/77)of the control group(P<0.05).During the 1-year follow-up,there was no significant difference in the incidence of MACE and other serious adverse events between the two groups(P>0.05).Conclusion Coronary CTA is of high value in evaluating the need for ICA in low-risk NSTEMI patients,and it can significantly reduce the number of ICA and effectively improve the positive rate of ICA,so as to shorten the hospitalization time,reduce the hospitalization cost and improve their anxiety and depression.