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

发布时间：2018-05-17 01:38

本文选题：冠状血管 + 体层摄影术　；参考：《中国医学影像技术》2017年10期

【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(P0.05),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。
[Abstract]:Objective to evaluate the value of coronary CT angiography (CCTA) in predicting major adverse cardiac events in patients with coronary plaque. Methods CCTA was performed in 256 patients with coronary atherosclerotic plaque. Coronary artery stenosis was quantitatively assessed on CCTA images and classified according to plaque composition. Following up the occurrence of MACE, three models were established to predict MACE (model 1, grade of coronary artery stenosis, model 2, grade of coronary artery stenosis combined with plaque classification of vessel wall). Model 3: classification of coronary artery stenosis combined with plaque classification and clinical risk factors were used to evaluate the predictive effectiveness of three models for MACE. Results out of 256 cases, 47 cases were lost and 209 cases were followed up. At the end of follow-up, 46 cases had MACEE. The risk ratio of coronary artery stenosis grade and plaque classification in assessing the risk of MACE was 4.47 ~ 3.43, which was higher than that of clinical risk factors. In model 2, the area under the ROC curve of model 3 was significantly larger than that of model 1 (P0.05), but there was no significant difference between model 2 and model 3 in predicting the area under ROC curve of MACE. Conclusion CCTA can quantitatively evaluate the degree of coronary artery stenosis and classify plaque. Combined use of CCTA can improve the predictive efficiency of MACE.
【作者单位】：上海市嘉定区中心医院放射影像科;上海市嘉定区中心医院超声影像科;
【基金】：上海市卫生与计划生育委员会科研项目(201440598) 上海市科委医学引导项目(134119b2300)
【分类号】：R543.3;R816.2

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