冠状动脉轻中度狭窄患者的预后影响因素分析

Prognostic Factors of Patients with Mild to Moderate Coronary Artery Stenosis

目的评价冠状动脉CT血管造影(CCTA)检出的冠状动脉轻中度狭窄患者主要心血管不良事件(MACE)的影响因素。方法采用前瞻性配对、对照设计方法,连续入选2015年1月至2017年12月因胸痛行CCTA检查的冠状动脉轻中度狭窄患者共计393例,通过CCTA确定高危斑块特征,留取静脉血检验生物学标志物,并对入组患者进行为期24个月的门诊或电话随访,记录其MACE事件的发生率(包括心源性死亡,心肌梗死,需住院的不稳定心绞痛或再血管化治疗)。结果 CCTA检出97例冠状动脉中度狭窄患者,检出有高危斑块特征患者136例,其中45例正性重构,61例低CT衰减,65例点状钙化,49例餐巾环征,77例具有2个及2个以上高危斑块特征。最终随访成功341例患者,随访成功率86.77%,随访期间共发生43例MACE事件,其中1例心源性死亡,13例发生心肌梗死,29例因不稳定心绞痛住院,17例行再血管化治疗。高危斑块特征正性重构、低CT衰减、点状钙化及餐巾环征的比例在MACE组均高于非MACE组,而冠状动脉中度狭窄的比例在两组无显著性差异。多因素Cox回归分析显示:年龄、血清高敏C反应蛋白(hs-CRP)、≥2个高危斑块特征及是否服用他汀治疗对MACE事件均有影响(P<0.05),而狭窄程度对MACE事件无影响(P>0.05)。Kaplan-Meier生存曲线显示:具有2个及2个以上高危斑块特征组的累积无事件生存率显著低于无高危斑块特征组,无论其是否合并冠状动脉中度狭窄。结论对于冠状动脉轻中度狭窄的患者,年龄、hs-CRP、≥2个高危斑块特征及是否服用他汀治疗是影响MACE事件的独立危险因素。

Objective Evaluation of the influencing factors of major adverse cardiovascular events in patients with coronary artery angiogram. Methods Totally 393 patients with mild-to-moderate coronary stenosis were included, high-risk plaque characteristicsdetermined by CCTA and blood biomarker measurements of hs-CRP were taken simultaneously. MACE incidences(including cardiac death, myocardial infarction, required hospital treatment for unstable angina or revascularization)were recorded through a 24-month follow-up. Results Among the 393 patients, 97 had moderate coronary stenosis, 45 had positive remodeling, 61 had low CT attenuation, 65 had point-like calcification, 49 had napkin ring and 77 had two or more high-risk plaque characteristics.341 patients were successfully followed up, high-risk plaque characteristics were higher in the MACE group than in the non-MACE group, while there was no significant difference in the proportion of moderate coronary stenosis in the two groups.COX regression analysis showed that age, hs-CRP,≥2 high-risk plaque characteristics and whether taking statins were independent risk factors for MACE(P< 0.05),while stenosis had no effects on MACE(P>0.05).Kaplan-meier survival curve showed that cumulative event-free survival was significantly lower in groups with two or more high-risk plaque characteristics than in groups without high-risk plaque characteristics, regardless of whether they were associated with moderate coronary stenosis. Conclusion For patients with mild-to-moderate coronary artery stenosis, age, HS-CRP,≥2 high-risk plaque characteristicsand statin therapy were independent risk factors for MACE events.