Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Cardiovascular Sciences, University of Milan, Milan, Italy.
JACC Cardiovasc Imaging. 2014 Jun;7(6):580-9. doi: 10.1016/j.jcmg.2014.04.003.
The goal of this study was to determine the long-term prognostic value of coronary computed tomography angiography (CTA) in a large coronary artery bypass graft (CABG) population.
Coronary CTA has shown prognostic utility in patients without previous revascularization. However, prognostication with coronary CTA in CABG patients has not been fully assessed.
Between March 2005 and April 2009, 887 consecutive CABG patients (mean age 66.8 ± 8.4 years) were considered for the inclusion in the study. Patients were classified by the number of unprotected coronary territories (UCTs) and a summary of native vessel disease and graft patency: the coronary artery protection score (CAPS). A primary endpoint (cardiovascular [CV] death, nonfatal myocardial infarction [MI]) and a secondary combined adverse events endpoint (CV death, MI, unstable angina, and late revascularizations) were recorded.
Among the 887 evaluated, 166 did not meet the inclusion criteria. The final study population consisted of 721 subjects. Ten patients were excluded for unevaluable coronary CTA images. Of the remaining 711 patients, follow-up (mean 73.5 ± 14 months) was obtained in 698. Three hundred forty-seven events were recorded. By univariable analysis, the strongest coronary CTA predictors of events were UCT 2 and 3 (hazard ratio [HR] for CV death/MI: 7.5 and 10.19, p < 0.0001 and p < 0.0003, respectively) and CAPS 4 (HR for CV death/MI: 24.1, p < 0.0001). A high number of UCTs was also a strong multivariable independent predictor of CV death/MI (HR: 7.78 and 10.18 for UCT 2 and 3, p < 0.0001 and p < 0.0007, respectively). Cumulative survival rates for CV death/MI and composite adverse CV events were 86% and 73% with UCT 0, 84% and 49% with UCT 1, 53% and 3% with UCT 2, and 29% and 0% with UCT 3, respectively.
Coronary CTA appears to be a promising tool for long-term risk stratification of CABG patients. The UCT score has significant prognostic value to predict CV deaths/MI.
本研究旨在确定冠状动脉计算机断层扫描血管造影（CTA）在大型冠状动脉旁路移植术（CABG）人群中的长期预后价值。
冠状动脉 CTA 已显示出在未经再血管化治疗的患者中的预后效用。然而，在 CABG 患者中，冠状动脉 CTA 的预后评估尚未得到充分评估。
在 2005 年 3 月至 2009 年 4 月期间，考虑将 887 例连续 CABG 患者（平均年龄 66.8 ± 8.4 岁）纳入研究。患者按无保护冠状动脉区域（UCTs）的数量和天然血管病变和移植物通畅性的总结进行分类：冠状动脉保护评分（CAPS）。记录主要终点（心血管[CV]死亡、非致死性心肌梗死[MI]）和次要联合不良事件终点（CV 死亡、MI、不稳定型心绞痛和晚期血运重建）。
在评估的 887 例患者中，有 166 例不符合纳入标准。最终研究人群包括 721 例患者。由于无法评估冠状动脉 CTA 图像，有 10 例患者被排除在外。在剩余的 711 例患者中，获得了 73.5 ± 14 个月的随访。记录了 347 例事件。通过单变量分析，事件的最强冠状动脉 CTA 预测因子是 UCT 2 和 3（CV 死亡/MI 的 HR：7.5 和 10.19，p<0.0001 和 p<0.0003）和 CAPS 4（CV 死亡/MI 的 HR：24.1，p<0.0001）。UCT 数量较多也是 CV 死亡/MI 的强烈多变量独立预测因子（UCT 2 和 3 的 HR：7.78 和 10.18，p<0.0001 和 p<0.0007）。CV 死亡/MI 和复合不良 CV 事件的累积生存率分别为 UCT 0 组为 86%和 73%，UCT 1 组为 84%和 49%，UCT 2 组为 53%和 3%，UCT 3 组为 29%和 0%。
冠状动脉 CTA 似乎是 CABG 患者长期风险分层的有前途的工具。UCT 评分具有显著的预后价值，可预测 CV 死亡/MI。
