[1]蔡今伦,贾耀文,张 平,等.冠状动脉CTA多参数在冠心病诊断及PCI术后心血管不良事件预测中的应用[J].介入放射学杂志,2025,34(09):935-940.[doi:10.3969/j.issn.1008-794X.2025.09.004]
　CAI Jinlun,JIA Yaowen,ZHANG Ping,et al.Application of multi-parameters of coronary CT angiography in diagnosing coronary heart disease and predicting major adverse cardiovascular events after percutaneous coronary intervention[J].J Intervent Med,2025,34(09):935-940.[doi:10.3969/j.issn.1008-794X.2025.09.004]
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冠状动脉CTA多参数在冠心病诊断及PCI术后心血管不良事件预测中的应用()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
34
期数:
2025年09
页码:
935-940
栏目:
心脏介入
出版日期:
2025-09-25

文章信息/Info

Title:
Application of multi-parameters of coronary CT angiography in diagnosing coronary heart disease and predicting major adverse cardiovascular events after percutaneous coronary intervention
文章编号:
1008-794X(2025)-009-0935-05
作者:
蔡今伦;  贾耀文;  张 平;  王立中
100144 北京 首都医科大学附属北京康复医院心脏康复中心
Author(s):
CAI Jinlun; JIA Yaowen; ZHANG Ping; WANG Lizhong.
Cardiac Rehabilitation Center,Affiliated Beijing Rehabilitation Hospital of Capital Medical University,Beijing 100144,China
关键词:
经皮冠状动脉介入;  冠心病;  冠状动脉CT血管造影;  心血管不良事件
分类号:
R654.2
DOI:
10.3969/j.issn.1008-794X.2025.09.004
文献标志码:
A
摘要:
目的 分析冠状动脉CT血管造影(CTA)多参数在冠心病诊断及经皮冠状动脉介入治疗(PCI)术后主要心血管不良事件(MACE)预测中的应用价值。方法 纳入2021年1月至2024年1月首都医科大学附属北京康复医院接受PCI手术的冠心病患者350例作为观察组,同时期怀疑冠心病行冠状动脉CTA及冠状动脉造影(CAG)排除冠状动脉病变者180例作为对照组。根据PCI术后6个月是否发生MACE进一步将观察组分为MACE组、非MACE组,比较观察组与对照组、MACE组与非MACE组的CTA参数,包括斑块总体积(TPV)、斑块负荷(PB)、重塑指数(RI)、冠状动脉周围脂肪衰减系数(FAI)、斑点钙化、餐巾环征。Logistic回归分析PCI术后MACE发生的独立影响因素,采用受试者工作特征曲线下面积(AUC)分析各指标对PCI术后6个月发生MACE的预测效能。结果 观察组TPV、PB、RI、FAI值及斑点钙化、餐巾环征检出率均高于对照组(P<0.05); 观察组350例患者,术后6个月内共54例(15.43%)发生MACE,其中心源性死亡5例(1.43%)、非致命性心肌梗死22例(6.29%)、支架内再狭窄所致靶血管重建15例(4.29%)、心力衰竭住院12例(3.43%),均纳入MACE组,余296例纳入非MACE组。MACE组TPV、PB、RI、FAI值及餐巾环征检出率均高于非MACE组(P<0.05); Logistic多因素分析显示,TPV、PB、FAI均为冠心病患者PCI术后MACE发生的独立影响因素(P<0.05); ROC曲线显示,TPV、PB、FAI预测PCI术后6个月MACE的敏感度分别为65.40%、76.90%、76.90%,特异度分别为63.80%、72.50%、73.80%,联合检测的敏感度、特异度为96.20%、71.80%,AUC为0.896。结论 冠状动脉CTA多参数在冠心病诊断及PCI术后MACE预测中具有重要应用价值,TPV、PB、FAI联合检测可为临床决策提供重要参考。

参考文献/References:

[1] Velusamy R,Nolan M,Murphy A,et al.Screening for coronary artery disease in cancer survivors:JACC:cardiooncology state-of-the-art review[J].JACC Cardio Oncol,2023,5:22-38.
[2]Kohsaka S,Ejiri K,Takagi H,et al.Diagnostic and therapeutic strategies for stable coronary artery disease following the ISCHEMIA trial[J].JACC Asia,2023,3:15-30.
[3]Mo Y,Xing B.Correlation between coronary CTA-SYNTAX score and invasive coronary angiography-SYNTAX score[J].Zhong Nan Da Xue Xue Bao Yi Xue Ban,2021,46:884-888.
[4]Lawton JS,Tamis-Holland JE,Bangalore S,et al.2021 ACC/AHA/SCAI guideline for coronary artery revascularization:executive summary:a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J].Circulation,2022,145:e4-e17.
[5]中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志,2016,44:382-400.
[6]Thygesen K,Alpert JS,Jaffe AS,et al.Fourth universal definition of myocardial infarction(2018)[J].J Am Coll Cardiol,2018,72:2231-2264.
[7]Hong SJ,Kim BK,Cho I,et al.Effect of coronary CTA on chronic total occlusion percutaneous coronary intervention:a randomized Trial[J].JACC Cardiovasc Imaging,2021,14:1993-2004.
[8]Dai N,Chen Z,Zhou F,et al.Coronary CT angiography-derived plaque characteristics and physiologic patterns for peri-procedural myocardial infarction and subsequent events[J].Eur Heart J Cardiovasc Imaging,2023,24:897-908.
[9]Liang S,Bai Y,Zhang J,et al.The added value of coronary CTA in chronic total occlusion percutaneous coronary intervention:a systematic review and meta-analysis[J].Eur Radiol,2024,34:4041-4052.
[10]Sonck J,Nagumo S,Norgaard B,et al.Clinical validation of a virtual planner for coronary interventions based on coronary CT angiography[J].JACC Cardiovasc Imaging,2022,15:1242-1255.
[11]李 蕾,徐 建,辛 奕,等.基于晚期CTA图像对急性大血管闭塞性卒中患者的评估价值及对治疗的指导作用[J].介入放射学杂志,2023,32:954-959.
[12]季宇萌,秦会园,陆小虎,等.心外膜脂肪体积与冠状动脉血管病变严重程度评估及预后的相关性研究[J].南京医科大学学报(自然科学版),2023,43:1108-1114.
[13]陈伟彬,李忠垚,张玄星,等.基于冠状动脉CTA研究冠状动脉斑块成分与血清Lp(a)水平的相关性[J].临床放射学杂志,2022,41:746-751.
[14]Berkovitch A,Finkelstein A,Barbash IM,et al.Evaluation of coronary disease among patients undergoing transcatheter aortic valve implantation:propensity score matching analysis[J].Clin Res Cardiol,2024,113:11-17.
[15]张晓雪,潘玉坤,谢瑞刚,等.冠状动脉CT血管成像在易损斑块诊断中的价值[J].中华放射学杂志,2024,58:822-828.
[16]王子荣,于 妲,蒲彩玲,等.冠状动脉CTA衍生的多参数与冠心病患者PCI血运重建关系分析[J].临床放射学杂志,2023,42:930-936.
[17]Liang S,Bai Y,Zhang J,et al.The added value of coronary CTA in chronic total occlusion percutaneous coronary intervention:a systematic review and meta-analysis[J].Eur Radiol,2024,34:4041-4052.
(收稿日期:2024-10-08)

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备注/Memo

备注/Memo:
通信作者: 王立中 E-mail:wanglizhongyangliu@163.com
更新日期/Last Update: 2025-09-25