关键词:

冠心病, 心肌缺血, 冠状动脉CT血管成像, 预测

Abstract:

Objective　To investigate the value of quantitative coronary CT angiography (CTA) parameters in predicting myocardial ischemic events in patients with coronary heart disease. Methods　A retrospective analysis of 110 patients with coronary heart disease treated in Hanzhong Central Hospital from November 2021 to June 2022. Based on the results of the blood flow reserve fraction test, the patients were divided into two groups: an ischemic group (75 cases) and a non-ischemic group (35 cases). In the ischemia group, there were 46 males and 29 females, 34 ≥60 years old and 41 <60 years old. In the non-ischemic group, there were 18 males and 17 females, 19 ≥60 years old and 16 <60 years old. Coronary CTA was conducted using a Canon 640-slice CT scanner. The total plaque volume, length, diameter stenosis, and joint prediction coefficient were compared between the two groups. The efficacy of the variables in predicting myocardial ischemia was analyzed using the receiver operating characteristic curve (ROC). The patients were followed up for 1 year, and major adverse cardiovascular events (MACE) were counted. According to the occurrence of MACE, the patients were divided into a MACE group (31 cases) and a non-MACE group (79 cases). The predictive value of the predictive coefficients for MACE was analyzed. Results　In the ischemic group, the total plaque volume, length, diameter stenosis, and joint prediction coefficient were (98.21±9.21) mm³, (4.79±1.67) mm, (19.80±4.47)%, and -3.84±2.33, respectively, and the above indexes in the non-ischemic group were (75.89±13.99) mm³, (3.44±1.10) mm, (13.16±4.09)%, and 2.91±2.81, respectively, with statistically significant differences (t=8.606, 5.011, 7.708, and -12.370, all P<0.001). The areas under the curves (AUCs) of the total plaque volume, length, diameter stenosis, and joint prediction coefficient in predicting myocardial ischemia were 0.898, 0.748, 0.859, and 0.968, respectively, and the AUC of the prediction coefficient was greater than those of the total plaque volume, length, and diameter stenosis, with statistically significant differences (all P<0.05). The prediction coefficient of the MACE group was -3.69[-5.16, -2.27], which was lower than that of the non-MACE group -1.81[-4.11, 2.75], with a statistically significant difference (Z=3.009, P=0.002). ROC analysis showed that the AUC of the predictive coefficient in predicting MACE in patients with coronary heart disease was 0.690. Conclusion　The combination of plaque CTA quantitative parameters with prediction coefficients is an effective method for predicting myocardial ischemic injury in patients with coronary heart disease. This approach is more accurate than relying on a single parameter and provides a valuable reference for clinical practice.

Key words:

Coronary heart disease, Myocardial ischemia, Coronary artery, CT angiography, Prediction