冠状动脉CT血管成像预测冠状动脉斑块患者发生主要不良心脏事件的价值

摘要

目的 探讨冠状动脉CT血管成像(CCTA)预测冠状动脉斑块患者发生主要不良心脏事件(MACE)的价值.方法 对256例冠状动脉粥样硬化斑块患者行CCTA检查,于CCTA图像上定量评定冠状动脉管腔狭窄程度,并依据斑块成分进行分型.随访MACE发生情况,建立预测MACE的3个模型(模型1,冠状动脉狭窄程度分级;模型2,冠状动脉狭窄程度分级联合管壁斑块分型;模型3:冠状动脉狭窄程度分级联合管壁斑块分型和临床危险因素指标),评估3个模型对MACE的预测效能.结果 256例病例中47例失访,最终随访209例患者.随访结束时,46例发生MACE.冠状动脉狭窄程度分级和斑块分型评估MACE发病风险的风险比分别为4.47、3.43,高于临床危险因素指标.模型2、模型3预测MACE的ROC曲线下面积明显大于模型1(P＜0.05),模型2和模型3预测MACE的ROC曲线下面积差异无统计学意义(P=0.076).结论 CCTA可定量评估冠状动脉管腔狭窄程度并进行斑块分型,联合应用有助于提高MACE的预测效能.%Objective To explore the value of coronary CT angiography (CCTA) in prediction of major adverse cardiac events (MACE) in patients with coronary plaques.Methods Totally 256 coronary atherosclerotic plaque patients underwent CCTA.The degree of coronary stenosis was assessed quantitatively,and the plaque components were analyzed and classified.The occurrence of MACE was followed up.Three models were established for predicting MACE,including model 1 (classification of CCTA stenosis),model 2 (classification of CCTA stenosis combined with plaque typing) and model 3 (CCTA combined with plaque typing and clinical risk factors).The ability of the three models to predict MACE was evaluated.Results Follow-up was completed in 209 patients.Forty-six patients had experienced MACE.Classification of CCTA stenosis and plaque typing were used to assess the risk of MACE,and the hazard ratio (HR) was 4.47 and 3.43,respectively,both higher than those of clinical risk factors.The predictive ability of MACE by model 2 and model 3 was significantly superior to that of model 1 (P＜0.05),and there was no significant difference between model 2 and model 3 (P=0.076).Conclusion CCTA can assess the risk of MACE from both coronary stenosis and plaque typing.The new modality of CCTA stenosis classification combined with plaque typing could promote the ability of CCTA to predict the risk of MACE.