Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands.
JACC Cardiovasc Imaging. 2017 Dec;10(12):1451-1458. doi: 10.1016/j.jcmg.2017.02.013. Epub 2017 May 17.
The aim of the present study was to evaluate, in low-to-intermediate pre-test probability patients who were referred for coronary computed tomography angiography (CTA) and did not show obstructive coronary artery disease (CAD), whether an intramural course of a coronary artery is associated with worse outcome compared with patients without an intramural course of the coronary arteries.
The prognostic value of an intramural course of the coronary arteries on coronary CTA in patients without obstructive CAD is not well-known.
The study population consisted of 947 patients with a low-to-intermediate pre-test probability who were referred for coronary CTA and who did not have obstructive CAD. During follow-up, the occurrence of unstable angina pectoris that required hospitalization, nonfatal myocardial infarction, and all-cause mortality was evaluated.
On coronary CTA, 210 patients (22%) had an intramural course of a coronary artery. The median depth of the intramural course was 1.9 mm (interquartile range: 1.4 to 2.6 mm). In 84 patients (40%), the depth of the intramural course was considered deep (>2 mm surrounded by myocardium). During a median follow-up of 4.9 years (interquartile range: 3.2 to 6.9 years), a total of 43 events occurred: hospitalization due to unstable angina pectoris in 13 patients (1.4%); 7 patients (0.7%) had a nonfatal myocardial infarction; and 23 patients died (2.4%). The 6-year cumulative event rate of unstable angina pectoris requiring hospitalization (0.0% vs. 1.1%), nonfatal myocardial infarction (0.5% vs. 0.4%), all-cause mortality (1.9% vs. 2.2%) as well as the combined endpoint of all 3 events (2.4% vs. 3.7%) was similar in patients with and without an intramural course of a coronary artery.
In patients without obstructive CAD on coronary CTA, the presence of an intramural course of a coronary artery was not associated with worse outcome.
本研究旨在评估在低至中度预检测概率患者中，那些因疑似冠状动脉疾病（CAD）而行冠状动脉计算机断层扫描血管造影（CTA）检查但未显示有阻塞性 CAD 的患者，其冠状动脉壁内走行与无冠状动脉壁内走行的患者相比，是否与更差的预后相关。
在无阻塞性 CAD 的冠状动脉 CTA 中，冠状动脉壁内走行的预测价值尚不清楚。
本研究纳入了 947 名低至中度预检测概率的患者，这些患者因疑似 CAD 而行冠状动脉 CTA 检查，且无阻塞性 CAD。在随访期间，评估了不稳定型心绞痛需住院、非致死性心肌梗死和全因死亡率的发生情况。
在冠状动脉 CTA 上，210 名患者（22%）存在冠状动脉壁内走行。冠状动脉壁内走行的中位数深度为 1.9 毫米（四分位间距：1.4 至 2.6 毫米）。在 84 名患者（40%）中，壁内走行深度被认为较深（>2 毫米被心肌环绕）。在中位数随访 4.9 年（四分位间距：3.2 至 6.9 年）期间，共发生 43 例事件：13 名患者（1.4%）因不稳定型心绞痛住院；7 名患者（0.7%）发生非致死性心肌梗死；23 名患者死亡（2.4%）。6 年时因不稳定型心绞痛住院的累积事件发生率（0.0% vs. 1.1%）、非致死性心肌梗死（0.5% vs. 0.4%）、全因死亡率（1.9% vs. 2.2%）以及所有 3 种事件的联合终点发生率（2.4% vs. 3.7%）在有和无冠状动脉壁内走行的患者之间相似。
在冠状动脉 CTA 上无阻塞性 CAD 的患者中，冠状动脉壁内走行与更差的预后无关。
