冠状动脉计算机断层扫描血管造影衍生参数对经皮冠状动脉介入术后主要不良心血管事件的预测价值

Prognostic value of coronary computed tomography angiography derived parameters for major adverse cardiovascular events after percutaneous coronary intervention

目的探究冠状动脉计算机断层扫描血管造影(CCTA)衍生参数对经皮冠状动脉介入(PCI)术后主要不良心血管事件(MACE)发生的预测价值。方法选取2021年2月至2023年2月期间于河北北方学院附属第一医院行PCI手术的225例急性ST段抬高型心肌梗死(STEMI)患者,所有患者均进行CCTA。术后采用到院复查的方式随访12个月,根据MACE的发生情况分为MACE发生组(n=59)及未发生组(n=157)。比较两组患者CCTA衍生参数[最小管腔面积(MLA)、斑块负荷(PB)、重塑指数(RI)及血流储备分数(FFR)]及临床资料的差异,采用logistic回归分析法分析PCI术后发生MACE的影响因素,通过绘制受试者工作特征曲线(ROC)分析CCTA衍生参数对PCI术后MACE的预测价值。结果216例患者中59例(27.31%)患者发生MACE;与MACE未发生组比较,MACE发生组PB水平升高,MLA、FFR水平降低(P<0.05),两组RI比较差异无统计学意义(P>0.05);MACE发生组有冠心病家族史占比、多支血管病变占比、植入支架数量均高于未发生组(P<0.05);多因素logistic模型分析结果显示,有冠心病家族史、多支血管病变、植入支架数量≥2个及PB高水平均是PCI术后发生MACE的独立危险因素(P<0.05),MLA、FFR高水平是PCI术后发生MACE的保护因素(P<0.05);ROC结果显示,MLA、PB及FFR单独及联合检测预测PCI术后MACE的曲线下面积(AUC)95%CI分别为0.681(0.615~0.743)、0.708(0.642~0.767)、0.736(0.672~0.793)及0.880(0.829~0.920),三者联合用于PCI术后MACE的预测效能优于各指标单独检测(Z=4.034、3.602、3.521,P<0.05)。结论PCI术后发生MACE的患者PB水平升高,MLA、FFR水平降低,三者均为PCI术后发生MACE的影响因素,联合使用对于PCI术后发生MACE具有较高的预测价值。

Objective To explore the value of coronary CT angiography(CCTA)derived parameters in predicting the occurrence of major adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI).Methods A total of 225 patients with acute ST elevation myocardial infarction(STEMI)who underwent PCI in our hospital from February 2021 to February 2023 were selected.After 12 months of follow-up performed in our hospital,the patients were divided into the MACE group(n=59)and the non-occurrence group(n=157)according to the occurrence of MACE.The differences of CCTA derived parameters[minimum lumen area(MLA),plaque load(PB),remodeling index(RI)and flow reserve fraction(FFR)]and clinical data between the two groups were compared.Logistic regression analysis was used to analyze the influencing factors of MACE after PCI.The predictive value of CCTA derived parameters to MACE after PCI was analyzed by drawing receiver operating characteristic curve(ROC).Results Among the 216 patients,59(27.31%)developed MACE.Compared with the non-MACE group,the PB level in the MACE group was increased,while the MLA and FFR levels were decreased(P<0.05).There was no statistical significance in RI level between the two groups(P>0.05).The proportion of family history of coronary heart disease,the proportion of multi-vessel disease and the number of implanted stents in MACE group were higher than those in non-MACE group(P<0.05).Multivariate logistic model analysis showed that family history of coronary heart disease,multi-vessel disease,number of implanted stents≥2 and high PB level were the independent risk factors for MACE after PCI(P<0.05).High levels of MLA and FFR were the protective factors for MACE after PCI(P<0.05).ROC results showed that the AUC(95%CI)of MACE after PCI predicted by MLA,PB and FFR alone and in combination were 0.681(0.615-0.743),0.708(0.642-0.767),0.736(0.672-0.793)and 0.880(0.829-0.920),respectively.The prediction efficiency of the combined test for MACE after PCI was better than that of each index alone(Z=4.034,3.602,3.521,P<0.05).Conclusion In the patients after PCI,the increased PB level and the decreased MLA and FFR levels were the influencing factors for MACE.The combined index test has a higher predictive value for the occurrence of MACE after PCI.