冠状动脉视觉钙化积分与冠状动脉狭窄的关系

The relationship between coronary visual calcification score and coronary stenosis

目的探讨冠状动脉视觉钙化积分(Shemesh积分)与冠状动脉狭窄的关系。方法回顾性分析2020年7月1日至2020年12月31日间六安市中医院心内科可疑冠心病行冠状动脉造影检查216例患者的临床资料和影像资料。统计比较Shemesh积分与冠状动脉狭窄的相关性;采用单因素和多因素logistic回归分析冠状动脉钙化的危险因素;采用Spearman秩相关分析冠状动脉钙化的Shemesh积分与病变血管数和Gensini积分的相关性;使用ROC曲线计算Shemesh积分并用来预测冠状动脉造影定量分析(QCA)≥50%和≥75%的曲线下面积(AUC)和确定最佳截断值。结果冠状动脉钙化预测QCA≥50%敏感度、特异度、阳性预测值、阴性预测值为85.5%、71.7%、78.1%、80.7%;在<60岁70例患者中,敏感度、特异度、阳性预测值、阴性预测值为77.3%、89.6%、77.3%、89.6%;在≥60岁146例患者中,敏感度、特异度、阳性预测值、阴性预测值为87.4%、54.9%、78.3%、70.0%。年龄、高血压、糖尿病、吸烟为冠状动脉钙化的独立危险因素。Shemesh积分与冠状动脉病变血管数、Gensini积分高度相关,左前降支(LAD)、左回旋支(LCX)、右冠状动脉(RCA)Shemesh积分与其Gensini积分中度相关;Shemesh积分预测QCA≥50%的AUC为0.859,Shemesh积分预测QCA≥75%的AUC为0.834。结论Shemesh积分与冠状动脉病变血管数和狭窄严重程度高度相关;Shemesh积分预测中、重度狭窄有一定的准确性。

Objective To determine whether the visual calcification score(Shemesh score)could assess the severity of coronary stenosis.Methods The clinical and image data of 216 patients with suspected coronary heart disease were included in this retrospective study,who underwent coronary angiography in the Cardiology Department of Luan Traditional Chinese Hospital from July 1,2020 to December 31,2020.Single-factor and multi-factor logistic regression were used to analyze the risk factors for coronary calcification;Spearman rank correlation was used to analyze the correlation of Shemesh score and Gensini score.The ROC curve was used to calculated the Shemesh score and predict the AUC[included quantitative coronary angiography(QCA)≥50%and QCA≥75%]and also to determine the optimal cutoff value.Results The analysis showed that the sensitivity,specificity,positive predictive value,and negative predictive values of QCA≥50%were 85.5%、71.7%、78.1%、80.7%respectively.The sensitivity,specificity,positive predictive value and negative predictive values were 77.3%、89.6%、77.3%、89.6%respectively in 70 patients with less than 60 years old.The sensitivity,specificity,positive predictive value and negative predictive values were 87.4%、54.9%、78.3%、70.0%respectively in 146 patients with more than 60 years old.The age,high blood pressure,diabetes and smoke were the independent risk factors of coronary artery calcification.Shemesh score had a strong correlation with the quantity of diseased coronary vessels and Gensini’s score.Shemesh score of Left anterior descending(LAD),Left circumflex(LCX)and Right coronary artery(RCA)had a moderate correlation with Gensini’s score.The AUC(QCA≥50%)and AUC(QCA≥75%)were 0.859 and 0.834 respectively through Shemesh score prediction.Conclusion Shemesh score had a strong correlation with the quantity of diseased coronary vessels and the severity of coronary stenosis.It could predict the moderate and severe stenosis to some extent.