何榕,韩江莉,许佳文,郭丽君,张福春,牛杰,李海燕,张永珍,王贵松,郭静萱,毛节明,高炜

• 1:北京大学第三医院心内科分子心血管学教育部重点实验室
• 2:北京大学第三医院放射科

摘要(Abstract)：

目的探讨冠状动脉钙化积分(CCS)对稳定性冠心病患者经皮冠状动脉介入治疗(PCI)后近、远期预后的预测价值。方法 109例稳定性心绞痛患者在首次PCI治疗前均接受冠状动脉CT检查,计算CCS;对患者进行长期随访,记录有无死亡、非致死性心肌梗死、靶病变血运重建以及再发心绞痛入院等主要心脏事件(MACE)发生。结果 CCS与患者年龄呈正相关(r=0.42,P=0.000),男性患者和糖尿病患者中CCS明显高于女性患者(590.8±764.5比352.8±336.3,t=2.25,P=0.026)和非糖尿病患者(693.3±912.4比413.0±464.1,t=2.11,P=0.037)。平均随访15个月(3～40个月),Kaplan-Meier生存分析发现CCS≤300,CCS301～1000和CCS>1000的患者累积无事件生存率差异有统计学意义(88.2%比81.6%比62.5%,Logrank7.49,P=0.024)。校正了年龄、性别、体重指数、糖尿病、高脂血症、多支病变、是否完全血运重建及PCI并发症后,多因素Cox回归分析显示CCS>1000的患者发生MACE的风险较CCS≤300的患者增加3.44倍(HR=3.44,P=0.043)。结论 CCS是预测稳定性冠心病患者PCI治疗后发生主要心脏事件的独立危险因子,对慢性稳定性冠心病患者的预后评价具有重要意义。

关键词(KeyWords)： 钙质沉着症;体层摄影术,X线计算机;冠状动脉疾病;血管成形术,经腔,经皮冠状动脉;预后

Abstract:

Keywords:

基金项目(Foundation): “十一五”国家科技支撑计划,冠心病早期诊断和综合治疗技术体系的研究(2006BAI01A02)

作者(Author): 何榕,韩江莉,许佳文,郭丽君,张福春,牛杰,李海燕,张永珍,王贵松,郭静萱,毛节明,高炜

参考文献(References)：

• [1]Achenbach S,Moselewski F,Ropers D,et al.Detection ofcalcified and noncalcified coronary atherosclerotic plaque bycontrast-enhanced,submillimeter multidetector spiral computedtomography:a segment-based comparison with intravascular ultrasound.Circulation,2004,109:14-17.
• [2]Sangiorgi G,Rumberger JA,Severson A,et al.Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans:a histologic study of723coronary artery segments using nondecalcifying methodology.J Am Coll Cardiol,1998,31:126-133.
• [3]Agatston AS,Janowitz WR,Hildner FJ,et al.Quantification of coronary artery calcium using ultrafast computed tomography.J Am Coll Cardiol,1990,15:827-832.
• [4]Detrano R,Guerci AD,Carr JJ,et al.Coronary calcium as a predictor of coronary events in four racial or ethnic groups.N Engl J Med,2008,358:1336-1345.
• [5]Shaw LJ,Raggi P,Callister TQ,et al.Prognostic value of coronary artery calcium screening in asymptomatic smokers and non-smokers.Eur Heart J,2006,27:968-975.
• [6]Greenland P,LaBree L,Azen SP,et al.Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals.JAMA,2004,291:210-215.
• [7]Pletcher MJ,Tice JA,Pignone M,et al.Using the coronary artery calcium score to predict coronary heart disease events:a systematic review and meta-analysis.Arch Intern Med,2004,164:1285-1292.
• [8]Budoff MJ,Shaw LJ,Liu ST,et al.Long-term prognosis associated with coronary calcification:observations from a registry of25,253patients.J Am Coll Cardiol,2007,49:1860-1870.
• [9]Laudon DA,Behrenbeck TR,Wood CM,et al.Computed tomographic coronary artery calcium assessment for evaluating chest pain in the emergency department:long-term outcome of a prospective blind study.Mayo Clin Proc,2010,85:314-322.
• [10]胡承恒,罗初凡,李怡,等.年龄与性别在冠状动脉钙化程度和冠心病诊断价值中的影响.中华心血管病杂志,2001,29:31-34.
• [11]Olson JC,Edmundowicz D,Becker DJ,et al.Coronary calcium in adults with type1diabetes:a stronger correlate of clinical coronary artery disease in men than in women.Diabetes,2000,49:1571-1578.
• [12]Iwasaki K,Matsumoto T,Aono H,et al.Prevalence of subclinical atherosclerosis in asymptomatic diabetic patients by64-slice computed tomography.Coron Artery Dis,2008,19:195-201.
• [13]Vattikuti R,Towler DA.Osteogenic regulation of vascular calcification:an early perspective.Am J Physiol Endocrinol Metab,2004,286:E686-696.
• [14]Speer MY,Giachelli CM.Regulation of cardiovascular calcification.Cardiovasc Pathol,2004,13:63-70.
• [15]冯君,罗初凡,伍贵富.急性心肌梗死与稳定性心绞痛患者电子束CT冠状动脉钙化的比较研究.中华心血管病杂志,2002,30:20-23.
• [16]Shemesh J,Apter S,Itzchak Y,et al.Coronary calcification compared in patients with acute versus in those with chronic coronary events by using dual-sector spiral CT.Radiology,2003,226:483-488.
• [17]Fitzgerald PJ,Ports TA,Yock PG.Contribution of localized calcium deposits to dissection after angioplasty.An observational study using intravascular ultrasound.Circulation,1992,86:64-70.
• [18]Brilakis ES,Best PJ,Elesber AA,et al.Incidence,retrieval methods,and outcomes of stent loss during percutaneous coronary intervention:a large single-center experience.Catheter Cardiovasc Interv,2005,66:333-340.
• [19]Mosseri M,Satler LF,Pichard AD,et al.Impact of vessel calcification on outcomes after coronary stenting.Cardiovasc Revasc Med,2005,6:147-153.