Williams Michelle C, Hunter Amanda, Shah Anoop, Assi Valentina, Lewis Stephanie, Mangion Kenneth, Berry Colin, Boon Nicholas A, Clark Elizabeth, Flather Marcus, Forbes John, McLean Scott, Roditi Giles, van Beek Edwin Jr, Timmis Adam D, Newby David E
British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
Heart. 2017 Jul;103(13):995-1001. doi: 10.1136/heartjnl-2016-310129. Epub 2017 Feb 28.
In patients with suspected angina pectoris, CT coronary angiography (CTCA) clarifies the diagnosis, directs appropriate investigations and therapies, and reduces clinical events. The effect on patient symptoms is currently unknown.
In a prospective open-label parallel group multicentre randomised controlled trial, 4146 patients with suspected angina due to coronary heart disease were randomised 1:1 to receive standard care or standard care plus CTCA. Symptoms and quality of life were assessed over 6 months using the Seattle Angina Questionnaire and Short Form 12.
Baseline scores indicated mild physical limitation (74±0.4), moderate angina stability (44±0.4), modest angina frequency (68±0.4), excellent treatment satisfaction (92±0.2) and moderate impairment of quality of life (55±0.3). Compared with standard care alone, CTCA was associated with less marked improvements in physical limitation (difference -1.74 (95% CIs, -3.34 to -0.14), p=0.0329), angina frequency (difference -1.55 (-2.85 to -0.25), p=0.0198) and quality of life (difference -3.48 (-4.95 to -2.01), p<0.0001) at 6 months. For patients undergoing CTCA, improvements in symptoms were greatest in those diagnosed with normal coronary arteries or who had their preventative therapy discontinued, and least in those with moderate non-obstructive disease or had a new prescription of preventative therapy (p<0.001 for all).
While improving diagnosis, treatment and outcome, CTCA is associated with a small attenuation of the improvements in symptoms and quality of life due to the detection of moderate non-obstructive coronary artery disease.
NCT01149590.
在疑似心绞痛患者中，CT冠状动脉造影（CTCA）可明确诊断、指导适当的检查和治疗并减少临床事件。目前尚不清楚其对患者症状的影响。
在一项前瞻性开放标签平行组多中心随机对照试验中，4146例因冠心病疑似心绞痛的患者按1:1随机分组，分别接受标准治疗或标准治疗加CTCA。使用西雅图心绞痛问卷和简明健康调查12项量表在6个月内评估症状和生活质量。
基线评分显示存在轻度身体受限（74±0.4）、中度心绞痛稳定性（44±0.4）、适度心绞痛发作频率（68±0.4）、极佳的治疗满意度（92±0.2）和中度生活质量受损（55±0.3）。与单纯标准治疗相比，6个月时CTCA组在身体受限改善方面改善程度较小（差异-1.74（95%可信区间，-3.34至-0.14），p=0.0329）、心绞痛发作频率改善方面（差异-1.55（-2.85至-0.25），p=0.0198）和生活质量改善方面（差异-3.48（-4.95至-2.01），p<0.0001）。对于接受CTCA的患者，症状改善在诊断为冠状动脉正常或预防性治疗停药的患者中最大，而在中度非阻塞性疾病患者或有预防性治疗新处方的患者中最小（所有p<0.001）。
虽然CTCA改善了诊断、治疗和预后，但由于检测到中度非阻塞性冠状动脉疾病，其与症状和生活质量改善的小幅减弱有关。
NCT01149590。
