Centro Cardiologico Monzino, IRCCS, Milan, Italy.
JACC Cardiovasc Imaging. 2012 Jul;5(7):690-701. doi: 10.1016/j.jcmg.2012.03.009.
The aim of this study was to assess the long-term prognostic role of multidetector computed tomography coronary angiography (CTA) in patients with suspected coronary artery disease (CAD).
Use of CTA is increasing in patients with suspected CAD. Although there is a large body of data supporting the prognostic role of CTA for major adverse cardiac events in the intermediate term, its long-term prognostic role in patients with suspected CAD is not well studied.
Between February 2005 and March 2008, 1,304 consecutive patients were prospectively studied with CTA for detecting the presence and assessing extent of CAD (disease extension and coronary plaque scores). Patients were classified according to the presence of normal coronaries and nonobstructive (<50%) and obstructive (>50%) coronary lesions. The composite rates of hard cardiac events (cardiac deaths and nonfatal myocardial infarctions) and all cardiac events (including late revascularization) were the endpoints of the study.
Seventy patients were excluded because their CTA data were uninterpretable. Of the remaining 1,234 patients, clinical follow-up (mean 52 ± 22 months) was obtained for 1,196 (97%). A total of 475 events were recorded, with 136 hard events (18 cardiac deaths and 118 nonfatal myocardial infarctions) and 123 late revascularizations. A total of 216 patients with early elective revascularizations were excluded from the survival analysis. Significant independent predictors of events in multivariate analysis were multivessel disease and left main CAD. Cumulative event-free survival was 100% for hard and all events in patients with normal coronary arteries, 88% for hard events and 72% for all events in patients with nonobstructive CAD, and 54% for hard events and 31% for all events in patients with obstructive CAD. Multivessel CAD was associated with a higher rate of hard cardiac events.
CTA provides prognostic information in patients with suspected CAD and unknown cardiac disease, showing excellent long-term prognosis when there is no evidence of atherosclerosis and allowing risk stratification when CAD is present.
本研究旨在评估多排螺旋 CT 冠状动脉成像（CTA）在疑似冠状动脉疾病（CAD）患者中的长期预后价值。
在疑似 CAD 患者中，CTA 的应用日益增多。尽管有大量数据支持 CTA 在中期对主要不良心脏事件的预后价值，但在疑似 CAD 患者中，其长期预后价值尚未得到充分研究。
2005 年 2 月至 2008 年 3 月，前瞻性研究了 1304 例连续疑似 CAD 患者的 CTA，以检测 CAD 的存在并评估其严重程度（病变范围和冠状动脉斑块评分）。患者根据正常冠状动脉和非阻塞性（<50%）及阻塞性（>50%）冠状动脉病变进行分类。硬终点为心脏不良事件（心脏死亡和非致死性心肌梗死）和所有心脏事件（包括晚期血运重建）的复合发生率。
70 例患者因 CTA 数据不可解释而被排除。在其余 1234 例患者中，1196 例（97%）获得了临床随访（平均 52±22 个月）。共记录到 475 例事件，其中 136 例硬终点事件（18 例心脏死亡和 118 例非致死性心肌梗死）和 123 例晚期血运重建。共有 216 例早期选择性血运重建患者被排除在生存分析之外。多变量分析中，硬终点事件的独立预测因素为多血管病变和左主干 CAD。在冠状动脉正常的患者中，硬终点和所有终点事件的累积无事件生存率为 100%；在非阻塞性 CAD 患者中，硬终点事件的无事件生存率为 88%，所有终点事件的无事件生存率为 72%；在阻塞性 CAD 患者中，硬终点事件的无事件生存率为 54%，所有终点事件的无事件生存率为 31%。多血管 CAD 与更高的硬心脏事件发生率相关。
CTA 为疑似 CAD 和未知心脏疾病患者提供预后信息，当无动脉粥样硬化证据时，显示出极好的长期预后，并在 CAD 存在时可进行风险分层。
