The diagnostic and prognostic value of coronary CT angiography in asymptomatic high-risk patients: a cohort study.
The diagnostic and prognostic value of coronary CT angiography in asymptomatic high-risk patients: a cohort study.
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DOI：
10.1136/openhrt-2014-000096
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发表时间：
2014
期刊：
影响因子：
2.7
通讯作者：
Feuchtner G
中科院分区：
文献类型：
--
作者：
Plank F;Friedrich G;Dichtl W;Klauser A;Jaschke W;Franz WM;Feuchtner G
前瞻性评估冠状动脉CT血管造影（CTA）在冠状动脉疾病（CAD）“先验”高风险无症状患者中的价值。采用冠状动脉钙化评分（CCS）和CTA前瞻性检查了711例具有高“先验”CAD风险的连续无症状患者（61.8岁; 40.1%女性）。评价冠状动脉粥样硬化斑块（非钙化和钙化）和狭窄（轻度<50%，中度50-70%或高度>70%）。计算冠状动脉节段受累评分（SIS，有斑块的节段总数）和nc（非钙化）SIS。主要终点为主要不良心脏事件（ST段抬高型MI、非ST段抬高型MI和心源性死亡）;次要终点为冠状动脉血运重建和侵入性血管造影显示狭窄>50%。在711例患者中，CTA显示28.3%的患者CAD阴性，71.7%的患者CAD阳性（CAD+）（15.6%的患者存在无狭窄的斑块，23.9%的患者存在轻度狭窄，10.7%的患者存在中度狭窄，21.5%的患者存在高度狭窄）。CCS零患病率为306例（43%），其中100例（32.7%）仅有非钙化斑块。平均随访时间为2.65年。 冠状动脉造影阴性者MACE发生率为0%，冠状动脉造影阳性者MACE发生率较高（1.2%）。冠状动脉血运重建率为5.5%。SIS ≥5的患者MACE的HR为6.5（95% CI 1.6 - 25.8，p<0.013），ncSIS ≥1的患者次要终点的HR为2.4（95% CI 1.2 - 4.6，p<0.01）。CTA对狭窄>50%的敏感性为92.9%（95%CI 83.0%~ 98.1%）。CTA对联合终点的阴性预测值为99.4%（95% CI 98.3%-99.8%）。无症状高危患者中CTA显示的CAD患病率较高。CCS零不排除CAD。CTA高度准确地排除CAD。总冠状动脉斑块负荷和nc斑块，即使仅累及一个节段，也与不良结局风险增加相关。
To prospectively assess the value of coronary CT angiography (CTA) in asymptomatic patients with high ‘a priori’ risk of coronary artery disease (CAD). 711 consecutive asymptomatic patients (61.8 years; 40.1% female) with high ‘a priori’ risk of CAD were prospectively examined with a coronary calcium score (CCS) and CTA. Coronary arteries were evaluated for atherosclerotic plaque (non-calcified and calcified) and stenosis (mild <50%, intermediate 50–70% or high-grade >70%). Coronary Segment Involvement Score (SIS, total number of segments with plaque) and nc (non-calcified) SIS were calculated. Primary end points were major adverse cardiac events (ST-elevation MI, non-ST-elevation MI and cardiac death); secondary end points were coronary revascularisation and >50% stenosis by invasive angiography. Of 711 patients, 28.3% were negative for CAD and 71.7% positive (CAD+) by CTA (15.6% had plaques without stenosis, 23.9% mild, 10.7% intermediate and 21.5% high-grade stenosis). CCS zero prevalence was 306 (43%), out of those 100 (32.7%) had non-calcified plaque only. Mean follow-up period was 2.65 years. MACE rate was 0% in CAD negative and higher (1.2%) in CAD positive by CTA. Coronary revascularisation rate was 5.5%. Patients with SIS ≥5 had an HR of 6.5 (95% CI 1.6 to 25.8, p<0.013) for MACE, patients with ncSIS ≥1 had an HR of 2.4 (95% CI 1.2 to 4.6, p<0.01) for secondary end point. The sensitivity of CTA for stenosis >50% compared with invasive angiography was 92.9% (95% CI 83.0% to 98.1%). Negative predictive value of CTA was 99.4% (95% CI 98.3% to 99.8%) for combined end points. CAD prevalence by CTA in asymptomatic high-risk patients is high. CCS zero does not exclude CAD. CTA is highly accurate to exclude CAD. Total coronary plaque burden and nc plaques, even if only one segment is involved, are associated with an increased risk of adverse outcome.