Huang Zengfa, Chen Xiaowei, Wang Wanpeng, Du Xinyu, Cao Beibei, Li Mei, Yang Yang, Wang Xi, Huang Jiong, Zhu Jinghang, Zhao Xu, Wang Xiang
Department of Radiology, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, 26 Shengli Avenue, Jiangan, Wuhan, 430014, Hubei, China.
Department of Radiology, The Central Hospital of Wuhan Base, Hubei University of Medicine, Shiyan, 442000, Hubei, China.
Sci Rep. 2025 May 31;15(1):19153. doi: 10.1038/s41598-025-04147-5.
This study investigates the long-term prognostic significance of non-obstructive coronary artery disease (CAD) in predicting the risk of all-cause death in a multicenter study. Three hospitals in Wuhan participated in this retrospective, observational, multicenter study of 7320 patients with suspected of having CAD and who underwent clinical coronary computed tomography angiography (CTA) from June 2011 to December 2015. According to coronary CTA, the extent of CAD was categorized as non-obstructive, obstructive, and no CAD. The primary outcome was all-cause mortality. A total of 611 patients experienced all-cause mortality with a median duration of 8.0 years (7.2-8.9). The annualized mortality rate was 0.50 (95% CI: 0.43-0.58), 1.31 (95% CI: 1.16-1.47), and 2.18 (95% CI: 1.93-2.46) for the no CAD, non-obstructive CAD, and obstructive CAD, respectively. There was a significant association between the classification and the increased cumulative events, as shown by the Kaplan-Meier survival curve (P < 0.001). The multivariate Cox model showed that the hazard ratios (HR) for predicting all-cause mortality from 1.42 (95% CI: 1.15-1.75, P = 0.001) in non-obstructive CAD to 1.87 (95% CI: 1.50-2.33, P < 0.001) in obstructive CAD compared with no CAD. At 8-year follow-up, patients with non-obstructive CAD detected by coronary CTA had a 1.42-fold increased risk of all-cause mortality compared to patients without evidence of CAD. Thus, these findings suggest that non-obstructive CAD is clinically significant and that further investigation of interventions to improve the prognosis of these patients is warranted.
本研究在一项多中心研究中，调查了非阻塞性冠状动脉疾病（CAD）在预测全因死亡风险方面的长期预后意义。武汉的三家医院参与了这项回顾性、观察性多中心研究，研究对象为2011年6月至2015年12月期间7320例疑似患有CAD且接受了临床冠状动脉计算机断层扫描血管造影（CTA）的患者。根据冠状动脉CTA，CAD的程度分为非阻塞性、阻塞性和无CAD。主要结局为全因死亡率。共有611例患者发生全因死亡，中位持续时间为8.0年（7.2 - 8.9年）。无CAD、非阻塞性CAD和阻塞性CAD的年化死亡率分别为0.50（95%CI：0.43 - 0.58）、1.31（95%CI：1.16 - 1.47）和2.18（95%CI：1.93 - 2.46）。如Kaplan-Meier生存曲线所示，分类与累积事件增加之间存在显著关联（P < 0.001）。多变量Cox模型显示，与无CAD相比，预测非阻塞性CAD全因死亡率的风险比（HR）为1.42（95%CI：1.15 - 1.75，P = 0.001），阻塞性CAD为1.87（95%CI：1.50 - 2.33，P < 0.001）。在8年随访中，经冠状动脉CTA检测出患有非阻塞性CAD的患者全因死亡风险比无CAD证据的患者高1.42倍。因此，这些发现表明非阻塞性CAD具有临床意义，有必要进一步研究改善这些患者预后的干预措施。
