基于CCTA的非阻塞性冠状动脉疾病近端病变的预后价值研究

Prognostic Value of Proximal Lesions in Non-Obstructive Coronary Artery Disease Based on Coronary CT Angiography

目的 探讨基于冠状动脉CT血管造影(CCTA)的冠状动脉近端病变在非阻塞性冠状动脉疾病(NOCAD)中的预后价值。方法 连续性搜集本院2017年11月至2019年12月临床确诊或疑似冠心病患者,最终3359例患者纳入研究。采用单因素和多因素COX回归探索影响主要不良心血管事件(MACE)的风险因素。结果 NOCAD组患者平均年龄高于CCTA正常组(P<0.001),NOCAD组中男性、吸烟、饮酒、高血压和糖尿病比例高于正常组(P<0.001)。近端病变NOCAD组人群平均年龄及高血压高于非近端病变NOCAD组(P<0.05),两组在性别、吸烟、饮酒、糖尿病比较中,差异无统计学意义(P>0.05)。近端病变NOCAD发生154例MACE,发生率为10.58%,年发生率为2.8%(95%CI:2.4%~3.3%)。近端病变NOCAD组发生MACE事件风险是正常组的1.45倍(95%CI:1.09~1.91,P=0.010);非近端病变NOCAD组是正常组发生MACE事件风险的1.09倍(95%CI:0.67~1.78),但是差异无统计学意义(P=0.735)。结论 基于CCTA的NOCAD近端病变发生MACE事件风险是CCTA正常人群的1.45倍。基于CCTA的斑块位置可能为NOCAD患者提供风险分层信息,为后续进一步研究提供启发作用。

Objective To explore the prognostic value of proximal lesions based on coronary CT angiography(CCTA) in non-obstructive coronary artery disease(NOCAD). Methods Finally 3359 patients with clinically confirmed or suspected coronary artery disease(CAD) in our hospital from November 2017 to December 2019 were continuous collected. Univariate and Multivariate Cox regression models were used to explore the risk factors of MACE. Results The mean age of patients in the NOCAD group was higher than that in no CAD group, the proportion of men in the NOCAD group was higher than that in no CAD group, and the proportion of smoking, drinking, hypertension and diabetes was higher than that in no CAD group(P<0.001).The mean age and proportion of people with hypertension in NOCAD with proximal lesions group was higher than that in NOCAD without proximal lesions group(P<0.05).There was no significant difference between the two groups in age, gender, smoking, drinking and hypertension(P>0.05).154 patients occurred MACE in NOCAD with proximal lesions group. The incidence rate of MACE was 10.58% and the annual incidence rate of MACE was 2.8%(95% CI:2.4%-3.3%).The HR of NOCAD with proximal lesions group was 1.45(95% CI:1.09-1.91,P=0.010), when no CAD was used as reference. The HR of NOCAD without proximal lesions group was 1.01(95% CI:0.67-1.78,P=0.735),when no CAD was used as reference. Conclusion The proximal lesions of NOCAD based on CCTA were 1.45 times higher than those of no CAD. The plaque location based on CCTA may provide additional prognostic value for MACE risk prediction in patients with NOCAD.