Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Division of Cardiology, Korea University Anam Hospital, Seoul, Republic of Korea.
Sci Rep. 2021 May 18;11(1):10513. doi: 10.1038/s41598-021-90133-6.
Identification of obstructive coronary artery disease (OCAD) in patients with chest pain is a clinical challenge. The value of corrected QT interval (QTc) for the prediction of OCAD has yet to be established. We consecutively enrolled 1741 patients with suspected angina. The presence of obstructive OCAD was defined as ≥ 50% diameter stenosis by coronary angiography. The pre-test probability was evaluated by combining QTc prolongation with the CAD Consortium clinical score (CAD2) and the updated Diamond-Forrester (UDF) score. OCAD was detected in 661 patients (38.0%). QTc was longer in patients with OCAD compared with those without OCAD (444 ± 34 vs. 429 ± 28 ms, p < 0.001). QTc was increased by the severity of OCAD (P < 0.001). QTc prolongation was associated with OCAD (odds ratio (OR), 2.27; 95% confidence interval (CI), 1.81-2.85). With QTc, the C-statistics increased significantly from 0.68 (95% CI 0.66-0.71) to 0.76 (95% CI 0.74-0.78) in the CAD2 and from 0.64 (95% CI 0.62-0.67) to 0.74 (95% CI 0.72-0.77) in the UDF score, respectively. QT prolongation predicted the presence of OCAD and the QTc improved model performance to predict OCAD compared with CAD2 or UDF scores in patients with suspected angina.
在胸痛患者中识别阻塞性冠状动脉疾病(OCAD)是一项临床挑战。校正 QT 间期(QTc)对 OCAD 的预测价值尚未确定。我们连续纳入了 1741 名疑似心绞痛患者。通过冠状动脉造影将阻塞性 OCAD 的存在定义为≥50%的直径狭窄。通过将 QTc 延长与 CAD 联合会临床评分(CAD2)和更新的 Diamond-Forrester(UDF)评分相结合,评估了预测试概率。在 661 名患者(38.0%)中发现了 OCAD。与无 OCAD 的患者相比,有 OCAD 的患者的 QTc 更长(444±34 vs. 429±28 ms,p<0.001)。OCAD 的严重程度与 QTc 延长相关(P<0.001)。QTc 延长与 OCAD 相关(比值比(OR),2.27;95%置信区间(CI),1.81-2.85)。使用 QTc,C 统计量分别从 CAD2 的 0.68(95%CI 0.66-0.71)显著增加到 0.76(95%CI 0.74-0.78)和 UDF 评分的 0.64(95%CI 0.62-0.67)增加到 0.74(95%CI 0.72-0.77)。QT 延长预测了 OCAD 的存在,与 CAD2 或 UDF 评分相比,QTc 可改善预测 OCAD 的模型性能。
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