冠状动脉钙化评分对择期经皮冠状动脉介入治疗患者围手术期心肌梗死的预测价值

Coronary artery calcium score in predicting periprocedural myocardial infarction in patients undergoing an elective percutaneous coronary intervention.

作者信息

Kang Min Gyu, Kang Yoomee, Jang Hyun Gyung, Kim Kyehwan, Koh Jin-Sin, Park Jeong Rang, Hwang Seok-Jae, Hwang Jin-Yong, Bae Jae Seok, Ahn Jong-Hwa, Jang Jeong Yoon, Park Yongwhi, Jeong Young-Hoon, Kwak Choong Hwan, Park Hyun Woong

机构信息

Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju.

Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.

出版信息

Coron Artery Dis. 2018 Nov;29(7):589-596. doi: 10.1097/MCA.0000000000000651.

DOI:10.1097/MCA.0000000000000651

PMID:29965838

Abstract

BACKGROUND

This study aimed to evaluate whether the coronary artery calcium score (CACS) measured with computed tomography coronary angiography (CTCA) predicts periprocedural myocardial infarction (PMI) in patients undergoing an elective percutaneous coronary intervention (PCI).

PATIENTS AND METHODS

A total of 197 patients with stable angina underwent elective PCI after CTCA. We evaluated CACS using CTCA and assessed the clinical risk factors for PMI. PMI was defined as an elevation of troponin I levels exceeding five times the upper limit of normal within 24 h after PCI. Patients were followed up for major adverse cardiovascular events for a median of 4.6 years.

RESULTS

The prevalence of PMI was 18.7% (37 patients) and patients with PMI showed a trend toward a higher CACS (721±779 vs. 498±842, P=0.142). The prevalence of PMI showed a positive correlation with the CACS distribution [8.0%, first interquartile range (IQR); 14.3%, second IQR; 22.4%, third IQR; 30.6%, fourth IQR; P=0.002]. The CACS cut-off value for PMI was greater than 113 (area under the curve: 0.670; 95% confidence interval: 0.600-0.736; P<0.001). Patients with CACS greater than 113 before PCI showed a higher prevalence of PMI (26.2 vs. 5.6%, odds ratio: 5.994; P<0.001). Multivariate analysis showed that CACS greater than 113 was the main predictor for PMI (odds ratio: 3.61, 95% confidence interval: 1.145-11.363; P=0.028). In this study, the cumulative incidence of major adverse cardiovascular event was higher in patients with PMI (54.1 vs. 10.6%; P<0.001).

CONCLUSION

This study suggests that high CACS measured with CTCA influences the occurrence of PMI, which is associated with worse cardiovascular outcomes.

摘要

背景

本研究旨在评估计算机断层扫描冠状动脉造影（CTCA）测量的冠状动脉钙化评分（CACS）是否能预测接受择期经皮冠状动脉介入治疗（PCI）患者的围手术期心肌梗死（PMI）。

患者与方法

共有197例稳定型心绞痛患者在CTCA后接受择期PCI。我们使用CTCA评估CACS，并评估PMI的临床危险因素。PMI定义为PCI后24小时内肌钙蛋白I水平升高超过正常上限的5倍。对患者进行主要不良心血管事件随访，中位随访时间为4.6年。

结果

PMI的患病率为18.7%（37例患者），PMI患者的CACS有升高趋势（721±779 vs. 498±842，P = 0.142）。PMI的患病率与CACS分布呈正相关[8.0%，第一四分位数间距（IQR）；14.3%，第二IQR；22.4%，第三IQR；30.6%，第四IQR；P = 0.002]。PMI的CACS截断值大于113（曲线下面积：0.670；95%置信区间：0.600 - 0.736；P < 0.001）。PCI前CACS大于113的患者PMI患病率更高（26.2%对5.6%，比值比：5.994；P < 0.001）。多变量分析显示，CACS大于113是PMI的主要预测因素（比值比：3.61，95%置信区间：1.145 - 11.363；P = 0.028）。在本研究中，PMI患者主要不良心血管事件的累积发生率更高（54.1%对10.6%；P < 0.001）。