Ahmadian Homayoun R, Thomas Dustin M, Shaw David J, Barnwell Megan L, Jones Ronald L, McDonough Ryan J, Prentice Ryan L, Lin Charles K, Slim Ahmad M
Cardiology Service MCHE-MDC, Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78234-6200, USA.
Int Sch Res Notices. 2014 Jul 2;2014:304825. doi: 10.1155/2014/304825. eCollection 2014.
Introduction. The purpose of this study is to investigate chest pain evaluations after initial coronary computed tomography angiography (CCTA) based upon coronary artery disease (CAD) burden. Methods. CCTA results of 1,518 patients were grouped based on the CCTA results into no CAD, nonobstructive CAD (<50% maximal diameter stenosis), or obstructive CAD (≥50% stenosis). Chest pain evaluation after initial CCTA and rates of major adverse cardiovascular events (MACE) defined as the incidence of all-cause mortality, nonfatal MI, ischemic stroke, and late revascularization (>90 days following CCTA) were evaluated. Results. MACE rates were higher with obstructive CAD compared to nonobstructive CAD and no CAD (8.9% versus 0.7%, P < 0.001; 8.9 versus 1.6%, P < 0.001). One hundred seventy-four patients (11.5%) underwent evaluation for chest pain after index CCTA with rates significantly higher with obstructive CAD compared to both nonobstructive CAD and no CAD (7.5% versus 13.9% versus 17.8%, P < 0.001). The incidence of repeat testing was more frequent in patients with obstructive CAD (no CAD 36.5% versus nonobstructive CAD 54.9% versus obstructive CAD 67.7%, P = 0.015). Conclusion. Absence of obstructive disease on CCTA is associated with lower rates of subsequent evaluations for chest pain and repeat testing with low MACE event rates over a 22-month followup.
引言。本研究的目的是基于冠状动脉疾病（CAD）负担调查初次冠状动脉计算机断层扫描血管造影（CCTA）后的胸痛评估情况。方法。1518例患者的CCTA结果根据CCTA结果分为无CAD、非阻塞性CAD（最大直径狭窄<50%）或阻塞性CAD（狭窄≥50%）。评估初次CCTA后的胸痛评估情况以及定义为全因死亡率、非致命性心肌梗死、缺血性中风和晚期血运重建（CCTA后>90天）发生率的主要不良心血管事件（MACE）发生率。结果。与非阻塞性CAD和无CAD相比，阻塞性CAD的MACE发生率更高（8.9%对0.7%，P<0.001；8.9%对1.6%，P<0.001）。174例患者（11.5%）在初次CCTA后接受了胸痛评估，阻塞性CAD患者的评估率显著高于非阻塞性CAD和无CAD患者（7.5%对13.9%对17.8%，P<0.001）。阻塞性CAD患者重复检测的发生率更高（无CAD为36.5%，非阻塞性CAD为54.9%，阻塞性CAD为67.7%，P=0.015）。结论。在22个月的随访中，CCTA显示无阻塞性疾病与随后胸痛评估率较低以及重复检测率较低和MACE事件发生率较低相关。
