CT血管成像对冠心病患者斑块状态、管腔狭窄的评估效果及临床应用价值

Evaluation effect and clinical application value of CT angiography on plaque status and luminal stenosis in patients with coronary heart disease

目的分析CT血管成像(CTA)对冠心病患者斑块状态、管腔狭窄的评估效果及临床应用价值,以期为临床寻找适宜的无创检查方法提供参考。方法回顾性分析郑州市第七人民医院2019年10月—2022年10月收治的166例冠心病患者的临床资料,以冠状动脉造影(CAG)为“金标准”,计算CTA与CAG检查结果的一致性。基于CTA比较不同狭窄程度患者的冠脉节段斑块类型,分析CTA冠脉斑块特征及狭窄程度对主要心脏不良事件(MACE)发生风险的影响。结果CAG共检出冠脉狭窄病变172处,CTA检出灵敏度、特异度及符合率分别为96.51%(166/172)、71.54%(352/492)、78.01%(518/664),与CAG结果的一致性良好(Kappa=0.818,P<0.001)。经CTA检查共检出89处冠脉斑块,轻度狭窄冠脉节段的非钙化(35.71%,10/28)、混合斑块(32.14%,9/28)占比分别较中/重度狭窄[57.37%(35/61)、39.34%(24/61)]冠脉节段低,轻度狭窄冠脉节段钙化斑块(32.14%,9/28)占比较中/重度狭窄(3.27%,2/61)冠脉节段高,差异均有统计学意义(P<0.05)。非钙化斑块体积、斑块长度及管腔直径狭窄率是MACE发生的独立影响因素(P<0.001)。结论CTA可较为准确地评估冠心病患者斑块状态、管腔狭窄情况。

Objective To evaluate the evaluation effect and clinical application value of CT angiography(CTA)on plaque status and lumen stenosis in patients with coronary heart disease,in order to provide reference for clinical search for appropriate non-invasive examination methods.Methods The clinical data of 166 patients with coronary heart disease admitted to the Seventh People's Hospital of Zhengzhou from October 2019 to October 2022 were retrospectively analyzed.Coronary angiography(CAG)was used as the"gold standard"to calculate the consistency of CTA and CAG results.The types of coronary segmental plaque in patients with different degrees of stenosis were compared based on CTA,and the effects of coronary plaque characteristics and stenosis degree on the risk of major adverse cardiac events(MACE)were analyzed.Results A total of 172 coronary stenosis lesions were detected by CAG,and the sensitivity,specificity and coincidence rate of CTA were 96.51%(166/172),71.54%(352/492)and 78.01%(518/664),respectively,which were in good agreement with the results of CAG(Kappa=0.818,P<0.001).A total of 89 coronary plaques were detected by CTA.The proportions of non-calcified plaques(35.71%,10/28)and mixed plaques(32.14%,9/28)in the mild stenosis segments were lower than those in the moderate/severe stenosis segments[57.37%(35/61),39.34%(24/61)].The proportion of calcified plaques in mild stenosis segments(32.14%,9/28)was higher than that in moderate/severe stenosis segments(3.27%,2/61),and the difference was statistically significant(P<0.05).Non-calcified plaque volume,plaque length and lumen diameter stenosis rate were independent risk factors for MACE(P<0.001).Conclusion CTA can accurately evaluate the plaque status and lumen stenosis in patients with coronary heart disease.