Prognostic value of multislice computed tomography coronary angiography in patients with known or suspected coronary artery disease
Prognostic value of multislice computed tomography coronary angiography in patients with known or suspected coronary artery disease
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DOI：
10.1016/j.jacc.2006.07.070
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发表时间：
2007-01-02
影响因子：
24
通讯作者：
Bax, Jeroen J.
中科院分区：
文献类型：
--
作者：
Pundziute, Gabija;Schuijf, Joanne D.;Bax, Jeroen J.
目的本研究旨在确定多层计算机断层扫描（MSCT）冠状动脉造影对已知或疑似冠状动脉疾病（CAD）患者的预后价值。背景预计MSCT将越来越多地作为一种替代成像方式用于疑似CAD患者的诊断。然而，目前还没有关于MSCT预后价值的数据。方法100例患者（73例男性，年龄59岁，12岁）因怀疑有明显的冠心病而被转诊作进一步心脏检查，并接受额外的MSCT冠状动脉造影来评估冠心病的存在和严重程度。随访患者发生情况：1)心源性死亡，2)非致死性心肌梗死，3)需要住院治疗的不稳定型心绞痛，4)血运重建术。结果80例（80%）患者检出冠状动脉斑块。在平均16个月的随访期间，26例患者发生了33个事件。在冠状动脉正常的MSCT患者中，第一年的事件发生率为0%，而有任何CAD证据的MSCT患者的事件发生率为30%。观察到的事件发生率最高的是存在阻塞性病变（63%）和当阻塞性病变位于左主干(LM)/左前降支（LAD）冠状动脉（77%）时。尽管如此，非阻塞性CAD患者的事件发生率也升高（8%）。在多变量分析中，事件的重要预测因子是CAD、阻塞性CAD、LM/LAD中阻塞性CAD的存在、有斑块的节段数量、有阻塞性斑块的节段数量和混合斑块的节段数量。结论多层计算机断层冠状动脉造影为已知和疑似CAD患者提供了基线临床危险因素的独立预后信息。MSCT正常的患者预后良好。(c) 2007年由美国心脏病学会基金会发布
Objectives This study sought to determine the prognostic value of multislice computed tomography (MSCT) coronary angiography in patients with known or suspected coronary artery disease (CAD).Background It is expected that MSCT will be used increasingly as an alternative imaging modality in the diagnosis of patients with suspected CAD. Data on the prognostic value of MSCT, however, are currently not available.Methods A total of 100 patients (73 men, age 59 12 years) who were referred for further cardiac evaluation due to suspicion of significant CAD underwent additional MSCT coronary angiography to evaluate the presence and severity of CAD. Patients were followed up for the occurrence of: 1) cardiac death, 2) nonfatal myocardial infarction, 3) unstable angina requiring hospitalization, and 4) revascularization.Results Coronary plaques were detected in 80 (80%) patients. During a mean follow-up of 16 months, 33 events occurred in 26 patients. In patients with normal coronary arteries on MSCT, the first-year event rate was 0% versus 30% in patients with any evidence of CAD on MSCT. The observed event rate was highest in the presence of obstructive lesions (63%) and when obstructive lesions were located in the left main (LM)/left anterior descending (LAD) coronary arteries (77%). Nonetheless, an elevated event rate was also observed in patients with nonobstructive CAD (8%). In multivariate analysis, significant predictors of events were the presence of CAD, obstructive CAD, obstructive CAD in LM/LAD, number of segments with plaques, number of segments with obstructive plaques, and number of segments with mixed plaques.Conclusions Multislice computed tomography coronary angiography provides independent prognostic information over baseline clinical risk factors in patients with known and suspected CAD. An excellent prognosis was noted in patients with a normal MSCT.(c) 2007 by the American College of Cardiology Foundation