Zhang Jing, Li Yuxi, Zheng Bo, Qiu Jianxing, Chen Xiahuan, Zhou Weiwei, Fan Yan, Liu Meilin
Department of Geriatrics, Peking University First Hospital, Beijing, 100034, People's Republic of China.
Department of Cardiology, Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, 100034, People's Republic of China.
Int J Gen Med. 2022 May 3;15:4603-4612. doi: 10.2147/IJGM.S357996. eCollection 2022.
To assess the diagnostic efficiency of a combination of symptoms, residual Syntax score (rSS) and non-invasive tests in elderly post-PCI patients.
This was a retrospective study that consecutively enrolled patients ≥60 years old with chronic coronary syndrome and previous stent implantation without lesions requiring further revascularization between March 2013 and June 2020. The patients were scheduled for exercise ECG, CCTA and invasive coronary angiography within 4 weeks. The study then calculated rSS and the sensitivity, specificity, positive and negative predictive values (PPV and NPV) and accuracy of symptoms, rSS, exercise ECG and CCTA, taking computational pressure-flow dynamics derived fractional flow reserve (caFFR) as the standard reference.
A total of 114 patients were enrolled in this study, including 75 patients with caFFR-positive and 39 patients with caFFR-negative. The caFFR-positive group had more patients with typical angina. Furthermore, the rSS in the caFFR-positive group was higher than that in the caFFR-negative category (7.33 ± 6.56 vs 3.34 ± 4.26, p < 0.001). There was no significant difference in exercise ECG results between the two groups. However, the rate of positive CCTA in the caFFR-positive group was higher than that in the caFFR-negative category (89.33% vs 46.15%, p < 0.001). In addition, after combining symptoms, rSS and CCTA, the sensitivity, specificity, PPV, NPV and accuracy for diagnose were 77.5%, 84.2%, 90.2%, 66.7% and 79.8%, respectively.
The findings showed that exercise ECG had limited power to diagnose significant CAD in elderly post-PCI patients, but CCTA was more efficient. Moreover, combining symptoms, rSS and CCTA provided more accurate diagnostic performance with feasibility and safety.
评估症状、残余Syntax评分（rSS）和非侵入性检查相结合在老年PCI术后患者中的诊断效能。
这是一项回顾性研究，连续纳入2013年3月至2020年6月期间年龄≥60岁、患有慢性冠状动脉综合征且既往有支架植入史且无需要进一步血运重建病变的患者。患者在4周内安排进行运动心电图、CCTA和有创冠状动脉造影。然后，该研究以计算压力-血流动力学衍生的血流储备分数（caFFR）作为标准参考，计算rSS以及症状、rSS、运动心电图和CCTA的敏感性、特异性、阳性和阴性预测值（PPV和NPV）及准确性。
本研究共纳入114例患者，其中caFFR阳性75例，caFFR阴性39例。caFFR阳性组典型心绞痛患者更多。此外，caFFR阳性组的rSS高于caFFR阴性组（7.33±6.56 vs 3.34±4.26，p<0.001）。两组运动心电图结果无显著差异。然而，caFFR阳性组CCTA阳性率高于caFFR阴性组（89.33% vs 46.15%，p<0.001）。此外，将症状、rSS和CCTA相结合后，诊断的敏感性、特异性、PPV、NPV和准确性分别为77.5%、84.2%、90.2%、66.7%和79.8%。
研究结果表明，运动心电图对老年PCI术后患者显著CAD的诊断能力有限，但CCTA效率更高。此外，将症状、rSS和CCTA相结合可提供更准确的诊断性能，且具有可行性和安全性。
