Casa de Saúde São José, Rua Macedo Sobrinho, 21 - Humaitá, Rio de Janeiro, 22271-080, RJ, Brazil; Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255 - Cidade Universitária, Rio de Janeiro, 21941-913, RJ, Brazil.
Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255 - Cidade Universitária, Rio de Janeiro, 21941-913, RJ, Brazil.
J Cardiovasc Comput Tomogr. 2017 Mar-Apr;11(2):148-152. doi: 10.1016/j.jcct.2016.12.006. Epub 2017 Jan 3.
Current Appropriatene Usa Criteria exclude coronary computed tomography angiography (CTA) in asymptomatic individuals. We compared the prognostic value of coronary CTA in asymptomatic individuals to symptomatic patients with "definitely appropriate" indications for coronary CTA.
Consecutive patients without previously known CAD referred for a CTA exam were divided into 2 groups. One group consisted ofasymptomatic individuals, the other of symptomatic patients with a "definitely appropriate" indication for coronary CT (unable to exercise and/or with an uninterpretable electrocardiogram and at an intermediate pre-test probability of obstructive coronary artery disease). Patients that did not fit into either groups were excluded. The segment stenosis score (SSS) was calculated based on coronary CTA and patients were followed for a composite endpoint of all-cause death, acute myocardial infarction and late revascularization.
A total of 1080 patients (60 ± 12 years, 65% male) were included in the study (674 "asymptomatic" and 406 "appropriate"). SSS >4 was more frequent in "asymptomatic" than in "appropriate" CT data sets (27% vs 20%, p = 0.02). After a mean follow-up of 4.4 ± 1.8 yrs, 49 patients reached the composite endpoint. On multivariable analysis adjusting for CAD risk factors and symptoms, only a high-risk CTA study and past smoking were independently predictive of events.
Although currently not regarded as "definitely appropriate", the use of coronary CTA in a selected asymptomatic population had higher yield for identifying high-risk individuals than appropriately indicated studies in symptomatic patients and provided thequal prognostic information.
当前美国适用标准排除了无症状个体的冠状动脉计算机断层扫描血管造影（CTA）。我们将无症状个体的冠状动脉 CTA 的预后价值与“明确适用”冠状动脉 CTA 适应证的有症状患者进行了比较。
连续无先前已知 CAD 的患者接受 CTA 检查，将其分为 2 组。一组为无症状个体，另一组为有“明确适应证”的症状患者（无法运动和/或心电图无法解释且存在阻塞性冠状动脉疾病的中等预测前概率）。未归入任何一组的患者被排除在外。根据冠状动脉 CTA 计算节段狭窄评分（SSS），并对患者进行随访，以全因死亡、急性心肌梗死和晚期血运重建的复合终点为指标。
共有 1080 例患者（60±12 岁，65%为男性）纳入研究（674 例“无症状”和 406 例“适当”）。“无症状”CT 数据集比“适当”CT 数据集更常见 SSS>4（27%比 20%，p=0.02）。平均随访 4.4±1.8 年后，49 例患者达到复合终点。多变量分析调整 CAD 危险因素和症状后，仅高危 CTA 研究和既往吸烟是独立的预测因素。
尽管目前不被视为“明确适应证”，但在选定的无症状人群中使用冠状动脉 CTA 比在有症状患者中进行“适当适应证”的研究更能识别高危个体，提供同样的预后信息。
