CAJ | 학술논문

目的探讨320排冠状动脉CT造影（ CCTA ）斑块特征和血管重构的预后价值。方法经320排CCTA检查的368例冠心病患者被随访18～28个月，平均（23±5.5）个月。研究终点是发生冠状动脉不良事件（心源性猝死、非致命性心肌梗死和不稳定型心绞痛）。 CCTA分析包括钙化斑块（ CP）、非钙化斑块（NCP）和混合斑块（MP）、梗阻性斑块、正性重构（PR）、偏心性斑块。通过手工测量血管横截面积定义重构指数（ RI），RI＝病变处血管横截面积/（病变处近端正常血管面积＋远端血管面积）/2。 RI＞1.10为PR， RI＜0.95为负性重构（ NR）。 RI＝0.95～1.10为无重构。结果368例1231个节段被发现存在动脉斑块，包括CP 155个节段（12.6％）、NCP 543个节段（44.1％）、MP 533个节段（43.3％）、梗阻性斑块188个节段（15.3％）、PR 145个节段（11.8％）、偏心性斑块1033个（83.9％）。随访期间，21例（5.6％）发生冠状动脉不良事件。单因素分析显示MP，与未并发冠状动脉不良事件斑块比较，梗阻性斑块、PR、偏心性斑块发生冠状动脉不良事件发病率高（分别是74.9％ vs．42.8％， P＝0.021；95.2％ vs．13.9％， P＜0.001；95.2％ vs．10.3％，P＜0.001；95.2％ vs．83.7％，P＝0.043）。多因素Cox比例风险回归模型分析显示仅梗阻性斑块[HR＝5.25（95％CI，2.17～12.69），P＜0.001]和PR[HR＝5.55（95％ CI，2.10～14.70），P＜0.001]是发生冠状动脉不良事件的独立预测因素。结论 CCTA表现为梗阻性斑块和PR，独立于其他CCTA高危因素，强烈暗示将来发生冠状动脉不良事件。
목적탐토320배관상동맥CT조영（ CCTA ）반괴특정화혈관중구적예후개치。방법경320배CCTA검사적368례관심병환자피수방18～28개월，평균（23±5.5）개월。연구종점시발생관상동맥불량사건（심원성졸사、비치명성심기경사화불은정형심교통）。 CCTA분석포괄개화반괴（ CP）、비개화반괴（NCP）화혼합반괴（MP）、경조성반괴、정성중구（PR）、편심성반괴。통과수공측량혈관횡절면적정의중구지수（ RI），RI＝병변처혈관횡절면적/（병변처근단정상혈관면적＋원단혈관면적）/2。 RI＞1.10위PR， RI＜0.95위부성중구（ NR）。 RI＝0.95～1.10위무중구。결과368례1231개절단피발현존재동맥반괴，포괄CP 155개절단（12.6％）、NCP 543개절단（44.1％）、MP 533개절단（43.3％）、경조성반괴188개절단（15.3％）、PR 145개절단（11.8％）、편심성반괴1033개（83.9％）。수방기간，21례（5.6％）발생관상동맥불량사건。단인소분석현시MP，여미병발관상동맥불량사건반괴비교，경조성반괴、PR、편심성반괴발생관상동맥불량사건발병솔고（분별시74.9％ vs．42.8％， P＝0.021；95.2％ vs．13.9％， P＜0.001；95.2％ vs．10.3％，P＜0.001；95.2％ vs．83.7％，P＝0.043）。다인소Cox비례풍험회귀모형분석현시부경조성반괴[HR＝5.25（95％CI，2.17～12.69），P＜0.001]화PR[HR＝5.55（95％ CI，2.10～14.70），P＜0.001]시발생관상동맥불량사건적독립예측인소。결론 CCTA표현위경조성반괴화PR，독립우기타CCTA고위인소，강렬암시장래발생관상동맥불량사건。
Objective To determine the predictive value of coronary atherosclerotic plaque characteristics and vascular remodeling on 320-raw coronary computed tomography angiography ( CCTA) for adverse coronary events in patients with coronary artery diseases .Methods The 368 consecutive patients with coronary artery diseases who underwent 320-raw CCTA examination and were followed for 18-28(23 ±5.5)month.The study endpoint was an adverse coronary event ( cardiac death , nonfatal myocardial infarction , or unstable angina pectoris ) .The CCTA analysis included the presence of calcified plaque (CP),non-calcified plaque(NCP),mixed plaque(MP),obstructive plaque,positive remodeling(PR),and eccentricity plaque.The manual inspection was used to define the remodeling index( RI) in the axial cross section area .RI=the axial cross section area at the plaque site/the axial cross section area proximal to the plaque site in a normal-appearing vessel segment +the axial cross section area distal to the plaque site in a normal-appearing vessel segment/2.The PR was defined by a RI >1.10,the NR was defined by a RI<0.95,and non-remodeling was defined by a RI =0.95-1.10.Results Of the 368 patients,the 1231 plaques were observed,including plaques with CP in 155(12.6%),with NCP in 543(44.1%),with MP in 533(43.3%), with obstructive plaque in 188 ( 15.3%) , with PR in 145 ( 11.8%) , with eccentricity plaque in 1033 ( 83.9%) . During the follow-up period , 21 patients ( 5.6%) experienced ACS events .Segment-based single factor analysis showed that MP ,obstructive plaque ,PR,and eccentricity plaque had a higher prevalence with adverse coronary event as compared without adverse coronary event (74.9% vs.42.8%,P=0.021,95.2% vs.13.9%,P<0.001,95.2%vs.10.3%,P<0.001,95.2%vs.83.7%,P=0.043,respectively).Segment-based Cox proportional hazards models analysis showed that only obstructive plaque [HR=5.25(95% CI,2.17-12.69),P<0.001]and PR[HR=5.55 (95% CI, 2.10-14.70 ), P <0.001 ] were independent predictive factors for future adverse coronary event . Conclusion The present study demonstrated that the obstructive plaque and PR demonstrated on CCTA was strongly associated with future adverse coronary events ,independent of other high-risk CCTA features .