Department of Medicine, Division of Cardiology, St. Luke's and Roosevelt Hospital New York, Columbia University College of Physicians and Surgeons, New York, NY, United States.
Int J Cardiol. 2013 May 25;165(3):468-73. doi: 10.1016/j.ijcard.2011.08.852. Epub 2011 Oct 2.
Prior studies have shown a consistent relationship between coronary artery calcium (CAC) scores or the degree of coronary stenoses on coronary computed tomography angiography (CCTA) and all-cause mortality. Whether CCTA-targeted therapy, including intensive medical management, stress testing and/or invasive coronary angiography (ICA), can lead to a substantial reduction in adverse outcomes is not yet known.
We retrospectively analyzed 691 patients (55±13 years, male=63%) from a single medical practice who underwent a CAC scan and CCTA and were followed for a mean of 2.9±1.0 years. Of these, 416 (60%) patients were asymptomatic. All changes in medications, coronary risk factors (including lipids profiles), downstream testing, revascularization procedures, and clinical events (myocardial infarction and death) were recorded.
Among our patients cohort 279 (40%) had no coronary artery disease. The most severe stenosis was <50% in 314 (46%) patients, 50-70% in 76 (11%) patients, and >70% in 22 (3%) patients. A high frequency of medical therapy was employed for those patients with any degree of stenosis, while stress testing was primarily applied for patients with >50% stenosis and ICA was primarily performed in those with >70% stenosis. Only two non-cardiovascular deaths and no cardiovascular deaths occurred during the follow-up period.
Our findings support the hypotheses that among patients undergoing CCTA, comprehensive medical management, including targeted percutaneous coronary interventions and increasingly intensive medical therapy with progressively worse CCTA findings, can reduce event rates among patients with abnormal CCTA studies.
先前的研究表明，冠状动脉钙（CAC）评分或冠状动脉计算机断层扫描血管造影（CCTA）上的冠状动脉狭窄程度与全因死亡率之间存在一致的关系。CCTA 靶向治疗，包括强化药物治疗、压力测试和/或有创冠状动脉造影（ICA），是否能显著降低不良结局，目前尚不清楚。
我们回顾性分析了来自单一医疗实践的 691 名患者（55±13 岁，男性=63%）的资料，这些患者接受了 CAC 扫描和 CCTA 检查，并随访了平均 2.9±1.0 年。其中，416 名（60%）患者无症状。记录了所有药物、冠状动脉危险因素（包括血脂谱）、下游检查、血运重建程序和临床事件（心肌梗死和死亡）的变化。
在我们的患者队列中，279 名（40%）患者无冠状动脉疾病。最严重狭窄<50%的患者有 314 名（46%），50-70%的患者有 76 名（11%），>70%的患者有 22 名（3%）。有任何程度狭窄的患者采用了高频药物治疗，而压力测试主要用于>50%狭窄的患者，ICA 主要用于>70%狭窄的患者。在随访期间，仅发生了 2 例非心血管死亡和 0 例心血管死亡。
我们的研究结果支持以下假设：在接受 CCTA 的患者中，综合药物治疗，包括有针对性的经皮冠状动脉介入治疗和随着 CCTA 结果逐渐恶化而逐渐强化的药物治疗，可以降低异常 CCTA 研究患者的事件发生率。
