Cai Zhongxing, Wang Yintang, Li Luqi, Wang Haoyu, Song Chenxi, Yin Dong, Song Weihua, Dou Kefei
Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China.
J Cardiovasc Dev Dis. 2021 Dec 14;8(12):186. doi: 10.3390/jcdd8120186.
Coronary artery ectasia (CAE) is a rare finding and is associated with poor clinical outcomes. However, prognostic factors are not well studied and no prognostication tool is available. In a derivation set comprising 729 consecutive CAE patients between January 2009 and June 2014, a nomogram was developed using Cox regression. Total of 399 patients from July 2014 to December 2015 formed the validation set. The primary outcome was 5-year major adverse cardiovascular events (MACE), a component of cardiovascular death and nonfatal myocardial infarction. Besides the clinical factors, we used quantitative coronary angiography (QCA) and defined QCA classification of four types, according to max diameter (< or ≥5 mm) and max length ratio (ratio of lesion length to vessel length, < or ≥1/3) of the dilated lesion. A total of 27 cardiovascular deaths and 41 nonfatal myocardial infarctions occurred at 5-year follow-up. The nomogram effectively predicted 5-year MACE risk using predictors including age, prior PCI, high sensitivity C-reactive protein, N-terminal pro-brain natriuretic peptide, and QCA classification (area under curve [AUC] 0.75, 95% CI 0.68-0.82 in the derivation set; AUC 0.71, 95% CI 0.56-0.86 in the validation set). Patients were classified as high-risk if prognostic scores were ≥155 and the Kaplan-Meier curves were well separated (log-rank < 0.001 in both sets). Calibration curve and Hosmer-Lemeshow test indicated similarity between predicted and actual 5-year MACE survival ( = 0.90 in the derivation and = 0.47 in the validation set). This study developed and validated a simple-to-use method for assessing 5-year MACE risk in patients with CAE.
冠状动脉扩张（CAE）是一种罕见的情况，且与不良临床结局相关。然而，预后因素尚未得到充分研究，也没有可用的预后评估工具。在一个由2009年1月至2014年6月期间连续纳入的729例CAE患者组成的推导队列中，使用Cox回归法构建了一个列线图。2014年7月至2015年12月期间的399例患者组成了验证队列。主要结局是5年主要不良心血管事件（MACE），包括心血管死亡和非致死性心肌梗死。除临床因素外，我们使用定量冠状动脉造影（QCA），并根据扩张病变的最大直径（<或≥5mm）和最大长度比（病变长度与血管长度之比，<或≥1/3）定义了四种类型的QCA分类。在5年随访中，共发生27例心血管死亡和41例非致死性心肌梗死。该列线图使用年龄、既往PCI、高敏C反应蛋白、N末端脑钠肽前体和QCA分类等预测因子有效预测了5年MACE风险（推导队列中曲线下面积[AUC]为0.75，95%CI为0.68 - 0.82；验证队列中AUC为0.71，95%CI为0.56 - 0.86）。如果预后评分≥155，则将患者分类为高危，且Kaplan-Meier曲线有良好的区分度（两组的对数秩检验均<0.001）。校准曲线和Hosmer-Lemeshow检验表明预测的和实际的5年MACE生存率相似（推导队列中P = 0.90，验证队列中P = 0.47）。本研究开发并验证了一种简单易用的方法，用于评估CAE患者的5年MACE风险。
