冠状动脉CT血管造影定量参数联合血清NTproBNP、sdLDL-C对冠状动脉粥样硬化性心脏病患者治疗后主要心血管不良事件的预测价值

Prognostic Value of Quantitative Parameters of Coronary CT Angiography Combined with Serum NT-proBNP and sdLDL-C for Major Cardiovascular Adverse Events in Patients with Coronary Atherosclerotic Heart Disease after Treatment

目的探讨冠状动脉CT血管造影(CCTA)定量参数与联合血清N末端脑利钠肽原(NT-proBNP)、小而密低密度脂蛋白胆固醇(sdLDL-C)对冠状动脉粥样硬化性心脏病(简称冠心病)患者经皮冠状动脉介入(PCI)术后主要心血管不良事件(MACE)的预测价值。方法招募2019年2月至2021年2月我院收治的248例拟行PCI的冠心病的患者,术前行CCTA检测获得血流储备分数(FFRCT)并检测血清NT-proBNP、sdLDL-C水平。术后随访1年,统计随访期间MACE发生情况,多因素Logistic回归分析影响冠心病患者PCI术后发生MACE的危险因素,绘制受试者工作特征曲线(ROC)分析FFRCT联合NT-proBNP、sdLDL-C预测冠心病患者PCI术后发生MACE的价值。结果248例患者中随访失联2例,余246例患者发生MACE 62例(MACE组),未发生MACE184例(非MACE组)。MACE组FFRCT低于非MACE组(P<0.05),血清NTproBNP、sdLDL-C水平高于非MACE组(P<0.05)。多因素Logistic回归分析结果显示年龄、冠脉病变支数3支及以上、术前TIMI 0级、高NT-proBNP、高sdLDL-C是冠心病患者PCI术后发生MACE的危险因素(P<0.05,OR>1),FFRCT是冠心病患者PCI术后发生MACE的保护因素(P<0.05,OR<1)。联合FFRCT、NT-proBNP和sdLDL-C预测冠心病患者PCI术后发生MACE的曲线下面积为0.854,高于单独指标预测的0.742、0.726、0.711。结论冠心病PCI术后MACE患者CCTA参数FFRCT降低,血清NTproBNP、sdLDL-C水平升高,且与冠心病患者PCI术后发生MACE相关,联合FFRCT、NT-proBNP和sdLDL-C在冠心病患者PCI术后MACE预测中具有较高价值。

Objective To investigate the value of quantitative parameters of coronary CT angiography(CCTA)combined with serum N-terminal probrain natriuretic peptide(NT-probNP)and small dense lowdensity lipoprotein cholesterol(sdLDL-C)in predicting major adverse cardiovascular events(MACE)in patients with coronary atherosclerotic heart disease(CHD)after percutaneous coronary intervention(PCI).Methods 248 patients with coronary heart disease who were expected to undergo PCI admitted to our hospital from February 2019 to February 2021 were recruited.Blood flow reserve fraction(FFRCT)was obtained by CCTA before surgery,and serum levels of NT-proBNP and sdLDL-C were detected.After 1 year of postoperative follow-up,the incidence of MACE during the follow-up period was statistically analyzed,and the risk factors of MACE in patients with coronary heart disease after PCI were analyzed by multivariate Logistic regression.Receiver operating characteristic curve(ROC)was drawn to analyze the value of FFRCT combined with NT-proBNP and sdLDL-C in predicting the occurrence of MACE after PCI in patients with coronary heart disease.Results Of the 248 patients,2 were lost during follow-up,and the remaining 246 patients developed MACE with 62 cases(MACE group)and did not develop MACE with 184 cases(non-MACE group).The FFRCT in the MACE group was lower than that in the non-MACE group(P<0.05),and the levels of serum NT-proBNP and sdLDL-C in the MACE group were higher than those in the non-MACE group(P<0.05).Multivariate Logistic regression analysis showed that age,three OR more coronary artery lesions,preoperative TIMI level 0,high NT-proBNP,high sdLDL-C were the risk factors for the occurrence of MACE in patients with coronary heart disease after PCI(P<0.05,OR>1).FFRCT was a protective factor for MACE in patients with coronary heart disease after PCI(P<0.05,OR<1).Combined with FFRCT,NT-proBNP and sdLDL-C,the area under the curve of predicting MACE in patients with coronary heart disease after PCI was 0.854,which was higher than 0.742,0.726 and 0.711 predicted by single index.Conclusion CCTA parameter FFRCT is decreased and serum NT-proBNP and sdLDL-C levels are increased in patients with coronary heart disease after PCI,which is correlated with the occurrence of MACE in patients with coronary heart disease after PCI.The combination of FFRCT,NT-proBNP and sdLDL-C has high value in the prediction of MACE in patients with coronary heart disease after PCI.