Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Klinik an der Technische Universität München, Munich, Germany.
Institut für Medizinische Informatik, Statistik und Epidemiologie, Klinikum rechts der Isar der Technische Universität München, Munich, Germany.
JACC Cardiovasc Imaging. 2019 Jul;12(7 Pt 2):1330-1338. doi: 10.1016/j.jcmg.2018.07.020. Epub 2018 Oct 17.
The aim of this study was to determine the long-term prognostic power of coronary computed tomography angiography (CTA) to predict cardiac death and nonfatal myocardial infarction.
Prognostic usefulness of coronary CTA has been confirmed for short- and intermediate-term follow-up. However, long-term data for prognostic usefulness is still lacking, but is paramount because of the slowly progressing nature of coronary artery disease (CAD).
A total of 2,011 patients with suspected but not previously diagnosed CAD were examined by coronary CTA. Mean follow-up was 10.0 years (interquartile range [IQR]: 8.1 to 11.2 years). Cox proportional hazards analysis was used for the composite endpoint of cardiac death and nonfatal myocardial infarction. Event-free survival, which was defined as the years it took to reach a cumulative 1% risk for the composite endpoint and reclassification from clinical risk, was calculated.
The study endpoint was reached in 58 patients (42 cardiac deaths, 16 nonfatal myocardial infarctions). Coronary CTA-assessed CAD severity (normal, nonobstructive, or obstructive) showed the best correlation with the endpoint, with an adjusted c-index of 0.704, compared with a univariate c-index of 0.622 for the clinical risk model (Morise score) alone. The annual event rate for patients with normal coronary arteries on baseline coronary CTA was 0.04%, which translated to an event-free survival period of 10 years. The highest annual event rate of 1.33% was found in patients with 3-vessel obstructive CAD. Reclassification from clinical risk (Morise score) was possible in approximately two-thirds of all patients (68%; p < 0.0001), which led to a substantial reduction of the intermediate-risk group (reduction from 74% to 15%) in favor of the low-risk group (increase from 20% to 83%).
Patients with normal coronary CTA results benefitted from an event-free survival period of 10 years against cardiac death and nonfatal myocardial infarction. Risk stratification according to coronary CTA results allowed for the delineation of clearly diverging prognostic groups and reclassified approximately two-thirds of all patients from clinical risk groups.
本研究旨在确定冠状动脉计算机断层扫描血管造影（CTA）预测心源性死亡和非致死性心肌梗死的长期预后能力。
冠状动脉 CTA 的预测作用已在短期和中期随访中得到证实。然而，关于其预后作用的长期数据仍然缺乏，但这是至关重要的，因为冠状动脉疾病（CAD）的进展是缓慢的。
对 2011 例疑似但未确诊 CAD 的患者进行冠状动脉 CTA 检查。平均随访时间为 10.0 年（四分位间距[IQR]：8.1 至 11.2 年）。采用 Cox 比例风险分析对心源性死亡和非致死性心肌梗死的复合终点进行分析。计算达到复合终点和临床风险重新分类的累计风险为 1%的无事件生存时间。
58 例患者（42 例心源性死亡，16 例非致死性心肌梗死）达到研究终点。冠状动脉 CTA 评估的 CAD 严重程度（正常、非阻塞性或阻塞性）与终点相关性最好，调整后的 c 指数为 0.704，而单独使用临床风险模型（Morise 评分）的单变量 c 指数为 0.622。基线冠状动脉 CTA 显示正常冠状动脉的患者每年的事件发生率为 0.04%，这意味着无事件生存时间为 10 年。3 支血管阻塞性 CAD 患者的年事件发生率最高，为 1.33%。约三分之二的患者（68%；p<0.0001）可以从临床风险（Morise 评分）中重新分类，这导致中间风险组（从 74%降至 15%）减少，低风险组（从 20%增至 83%）增加。
冠状动脉 CTA 结果正常的患者可避免心源性死亡和非致死性心肌梗死，无事件生存时间为 10 年。根据冠状动脉 CTA 结果进行风险分层可明确区分预后不同的患者，并对大约三分之二的患者从临床风险组重新分类。
