冠心病患者主要不良心脏事件的相关因素及CTA相关参数的诊断价值研究

Study on The Diagnostic Value of Major Adverse Cardiac Events and CTA Related Parameters in Patients with Coronary Heart Disease

目的研究冠心病患者主要不良心脏事件的相关因素及计算机断层扫描血管成像(CTA)相关参数的诊断价值。方法对2018年6月~2022年1月我院收治的238例冠心病患者进行为期1年的随访,后收集其临床资料,根据患者是否发生主要不良心脏事件将其分为不良事件组(43例)和非不良事件组(195例),统计两组一般资料及CTA影像学特点,采用多因素Logistic回归分析冠心病患者主要不良心脏事件发生的影响因素,采用受试者工作特征曲线(ROC)分析CTA参数对冠心病患者主要不良心脏事件发生的预测价值。结果多因素Logistic回归分析结果显示,有糖尿病、冠状动脉狭窄程度较高、CT血流储备分数(FFRCT)较低、斑块负荷较高均为冠心病患者主要不良心脏事件发生的独立危险因素(OR=2.552、4.067、2.729、3.059,P<0.05)。冠状动脉狭窄程度、FFRCT、斑块负荷联合预测冠心病患者主要不良心脏事件发生的曲线下面积(AUC)及特异度均高于三者单独预测(P<0.05);冠状动脉狭窄程度、联合敏感度高于斑块负荷,联合高于FFRCT(P<0.05);斑块负荷特异度高于冠状动脉狭窄程度、FFRCT(P<0.05)。结论冠心病患者主要不良心脏事件发生的独立危险因素包括有糖尿病、冠状动脉狭窄程度较高、FFRCT较低、斑块负荷较高,CTA参数冠状动脉狭窄程度、FFRCT、斑块负荷联合可有效提高对冠心病患者主要不良心脏事件发生的预测价值。

Objective To study the diagnostic value of computed tomography angiography(CTA)parameters and related factors of major adverse cardiac events in patients with coronary heart disease.Methods A 1-year follow-up was conducted on 238 patients with coronary heart disease admitted to our hospital from June 2018 to January 2022.Clinical data were collected and divided into the adverse event group(43 cases)and the non-adverse event group(195 cases)according to whether major adverse cardiovascular events occurred.General data and CTA imaging characteristics of the two groups were analyzed.Multivariate Logistic regression was used to analyze the influencing factors of major adverse cardiovascular events in patients with coronary heart disease,and receiver operating characteristic curve(ROC)was used to analyze the diagnostic value of CTA parameters in the occurrence of major adverse cardiovascular events in patients with coronary heart disease.Results Multivariate Logistic regression analysis showed that diabetes mellitus,higher degree of coronary artery stenosis,lower CT flow reserve fraction(FFRCT),and higher plaque load were all independent risk factors for major adverse cardiovascular events in patients with coronary heart disease(OR=2.552,4.067,2.729,3.059,P<0.05).The area under the Curve(AU C)and specificity of major adverse cardiovascular events in patients with coronary artery stenosis,FFRCT and plaque load combined diagnosis were higher than those diagnosed alone(P<0.05).The degree of coronary artery stenosis and combined sensitivity were higher than plaque load,and the combined sensitivity was higher than FFRCT(P<0.05).Plaque load specificity was higher than coronary stenosis degree and FFRCT(P<0.05).Conclusion Independent risk factors for major adverse cardiovascular events in patients with coronary heart disease included diabetes mellitus,higher degree of coronary artery stenosis,lower FFRCT,and higher plaque load.The combination of CTA parameters,degree of coronary artery stenosis,FFRCT,and plaque load could effectively improve the diagnostic value of major adverse cardiovascular events in patients with coronary heart disease.