冠状动脉周围脂肪测量对急性冠脉综合征患者远期预后的预测价值

Predictive value of pericoronary adipose tissue detectionto long-term prognosis in patients with acute coronary syndromes

目的研究冠状动脉(冠脉)周围脂肪测量指标对急性冠脉综合征(ACS)患者远期预后的预测价值。方法本研究共纳入自2020年1月至2021年1月期间于保定市第二医院收治的145例急性冠脉综合征患者,随访3年,根据随访中是否发生主要不良心血管事件(MACE)分为不良事件组和非不良事件组2组,对所有患者进行冠脉周围脂肪测量,分析其对急性冠脉综合征患者MACE发生的预测效应。结果MACE组与非MACE组患者的体质指数、高血压、三支病变及其冠脉斑块周围脂肪衰减指数(FAI)均具有统计学有差异(P<0.05)。Logistic回归分析显示,三支病变、LAD-FAI、LCX-FAI和RCA-FAI值均是ACS患者发生MACE的有效危险预测因素(P<0.05)。进一步绘制ROC曲线,结果显示,LADFAI、LCX-FAI和RCA-FAI值对MACE具有一定预测价值,AUC分别为0.927、0.951、0.986(95%CI:0.887~0.967、0.922~0.981、0.974~0.998,P<0.05),敏感性分别为74.6%、79.1%、97.1%,特异性分别为94.8%、96.1%、88.3%。结论冠脉周围脂肪测量可预测急性冠脉综合征患者心血管不良事件的发生,对远期预后的预测价值较大,建议临床推广。

Objective To study the predictive value of detection of pericoronary adipose tissue(PCAT)to long-term prognosis in patients with acute coronary syndromes(ACS).Methods ACS patients(n=145)were chosen from the Second Hospital of Baoding City from Jan.2020 to Jan.2021 and they were followed up for 3 y.All patients were divided,according to occurrence of major adverse cardiovascular events(MACE)during follow-up period,into MACE group and non-MACE group.All patients were given PCAT detection.The predictive efficacy of PCAT detection to MACE incidence was analyzed.Results The indexes of body mass index(BMI),hypertension,3-vessel lesion and fat attenuation index(FAI)of PCAT had statistical difference between 2 groups(P<0.05).The results of Logistic regression analysis showed that 3-vessel lesion,FAIleft anterior descending branch(LAD-FAI),FAIofleft circumflex of coronary artery(LCX-FAI)and FAIof right coronary artery(RCA-FAI)were effective risk predictive factors for MACE in ACS patients(all P<0.05).The results of ROC curve analysis showed that LADFAI,LCX-FAI and RCA-FAI had some predictive value to MACE,and AUC was,respectively,0.927,0.951 and 0.986(95%CI:0.887~0.967,95%CI:0.922~0.981 and 95%CI:0.974~0.998,P<0.05),sensitivity was,respectively,74.6%,79.1%and 97.1%,and specificity was,respectively,94.8%,96.1%and 88.3%.Conclusion The detection of PCAT can predict the occurrence of MACE and has a higher value to long-term prognosis in ACS patients,which is worth clinical promoting.