CTCA狭窄程度及局部心肌功能障碍与主要不良心脏事件的相关性研究

目的：探讨CT冠状动脉造影（CTCA）的冠状动脉狭窄程度联合左心室局部室壁运动功能在预测急性胸痛患者主要不良心脏事件（MACE）发生风险中的价值。方法：对294例急性胸痛患者进行冠脉CTA检查,评价冠状动脉狭窄程度及左心室局部运动功能,并对患者2年内MACE的发生进行随访。采用Kaplan-Meier法和COX风险模型来评价冠状动脉狭窄（≥50%）及左心室运动功能异常与MACE的相关性。结果：冠脉狭窄者MACE发生率（22.9%）是无明显狭窄者（1.6%）的14倍。无局部室壁运动异常（RWMA）与RWMA者其MACE发生率明显不同,在冠脉狭窄〈50%组其MACE发生率分别为0.9%和12.5%,在冠脉狭窄≥50%组其MACE发生率分别为8.1%和39.4%。结论：CTCA有助于提供急性胸痛患者发生MACE的预测信息。

Correlation of CTCA Stenosis Associated with Regional Myocardial Dysfunction and Major Adverse Cardiac Events

Objectives： To determine the prognostic value of coronary stenosis associated with regional ventricular motion abnormality by cardiac CT for predicting MACE（Major Adverse Cardiac Events, MACE） in patients with acute chest pain. Methods： 294 patients with acute chest pain were prospectively studied with a follow-up of 2 year for MACE, CT was assessed for the presence of plaque, stenosis（≥ 50% luminal narrowing）, and RWMA（Left Ventricular Regional Wall Motion Abnormalities, RWMA）. Kaplan-Meier method and COX risk models were made to evaluate the correlation between coronary artery stenosis（≥ 50%）, left ventricular dysfunction and MACE. Results： MACE rate of patients with stenosis was 14 fold of those without. There was evident difference of MACE rate between patients with RWMA positive and those negative. The rate of MACE in patients without evident stenosis（ 50%） was 0.9%（RWMA negative） and 12.5%（RWMA positive）, and 8.1%（RWMA negative） and 39.4%（RWMA positive） in those with stenosis（≥ 50）. Conclusion： Besides providing coronary anatomical and functional information, CTCA can also predict the occurrence of MACE, with good clinical prognosis value in patients with acute chest pain.