Lin Charles K, McDonough Ryan J, Prentice Ryan L, Thomas Dustin M, Steel Kevin E, Rubal Bernard J, Shry Eric A, Villines Todd C, Hulten Edward A, Slim Ahmad M
Cardiology Service, Brooke Army Medical Center, San Antonio, TX, USA.
Cardiology Service, Madigan Army Medical Center, Tacoma, WA, USA.
SAGE Open Med. 2014 May 2;2:2050312114533535. doi: 10.1177/2050312114533535. eCollection 2014.
Patient prognosis has been shown to directly correlate with the severity of coronary artery disease diagnosed by coronary computed tomography angiography (CCTA). Although the presence of coronary artery calcium has been associated with increased incidence of ischemic stroke, there are no data on the incidence of ischemic stroke based upon the severity of coronary artery disease by CCTA. Therefore, we sought to investigate the rate of major adverse cardiovascular events, including ischemic stroke, based upon the severity of coronary artery disease by CCTA over a 6-year period in a high-volume single military center.
We performed a retrospective chart review of all CCTA studies to evaluate the incidence of all-cause mortality, non-fatal myocardial infarction, ischemic stroke, and late revascularization (>90 days following CCTA) from January 2005 until July 2012. We reviewed 1518 CCTA reports, dividing patients into groups with obstructive (≥50% stenosis), non-obstructive (<50% stenosis), and no coronary artery disease (no angiographic disease). Subsequent major adverse cardiovascular events data (incidence of all-cause mortality, ischemic stroke, non-fatal myocardial infarction, and late revascularization) were obtained.
Over a review period of 6 years with a resultant median follow-up period of 22 months (interquartile range = 13-34 months), the major adverse cardiovascular events rate was significantly higher with obstructive coronary artery disease compared to both non-obstructive coronary artery disease and no coronary artery disease (8.9% vs 0.7%, p < 0.001; 8.9% vs 1.6%, p < 0.001). The incidence of ischemic stroke alone was also significantly higher in those with obstructive coronary artery disease compared to those with no coronary artery disease (3.8% vs 0.4%, p < 0.001).
Being free of disease on CCTA was associated with excellent cardiovascular prognosis. Obstructive coronary artery disease was associated with a significantly increased incidence of ischemic stroke. There was also a direct correlation between the severity of coronary artery disease on CCTA and cardiovascular prognosis over the follow-up period of 24 months.
患者预后已被证明与通过冠状动脉计算机断层扫描血管造影（CCTA）诊断的冠状动脉疾病严重程度直接相关。虽然冠状动脉钙化的存在与缺血性卒中发病率增加有关，但尚无基于CCTA评估的冠状动脉疾病严重程度的缺血性卒中发病率数据。因此，我们试图在一家大型单一军事中心，调查6年期间基于CCTA评估的冠状动脉疾病严重程度的主要不良心血管事件发生率，包括缺血性卒中。
我们对所有CCTA研究进行了回顾性病历审查，以评估2005年1月至2012年7月期间全因死亡率、非致命性心肌梗死、缺血性卒中和晚期血运重建（CCTA后>90天）的发生率。我们审查了1518份CCTA报告，将患者分为阻塞性（≥50%狭窄）、非阻塞性（<50%狭窄）和无冠状动脉疾病（无血管造影疾病）组。随后获得主要不良心血管事件数据（全因死亡率、缺血性卒中、非致命性心肌梗死和晚期血运重建的发生率）。
在6年的审查期内，中位随访期为22个月（四分位间距=13 - 34个月），与非阻塞性冠状动脉疾病和无冠状动脉疾病相比，阻塞性冠状动脉疾病的主要不良心血管事件发生率显著更高（8.9%对0.7%，p<0.001；8.9%对1.6%，p<0.001）。与无冠状动脉疾病的患者相比，阻塞性冠状动脉疾病患者单独缺血性卒中的发生率也显著更高（3.8%对0.4%，p<0.001）。
CCTA显示无疾病与良好的心血管预后相关。阻塞性冠状动脉疾病与缺血性卒中发生率显著增加相关。在24个月的随访期内，CCTA评估的冠状动脉疾病严重程度与心血管预后之间也存在直接相关性。
