何立芸,王方芳,韩江莉,米琳,许佳文,张福春,郭丽君,高炜

• 1:北京大学第三医院心内科
• 2:北京大学第三医院放射科

摘要(Abstract)：

目的研究冠状动脉钙化积分(CCS)与冠状动脉多支血管病变患者经皮冠状动脉介入治疗(PCI)后近、远期预后的关系。方法入选145例冠状动脉多支血管病变的冠心病患者,在PCI治疗前均接受了多排螺旋CT(MDCT)检查并计算CCS。根据CCS水平将患者分为三组:CCS≤100、CCS=101~400和CCS>400组。记录患者PCI操作相关并发症,随访记录患者PCI术后主要不良心血管事件(MACE)情况。结果 CCS>400组患者Syntax积分[(23.5±8.8)比(17.9±8.5),P<0.001]、三支血管病变的比率(75.4%比56.3%,P=0.015)和PCI操作相关并发症发生率(21.5%比5.0%,P=0.005)均显著高于CCS≤400组患者。所有患者随访360~2542 d(中位数952 d),Kaplan-Meier生存分析显示CCS≤100、CCS=101~400和CCS>400组患者累积无事件生存率差异无统计学意义(84.6%比78.0%比64.6%,P=0.141)。但女性患者中累积无事件生存率差异有统计学意义(100.0%比75.0%比50.0%,Log rank 6.836,P=0.033)。结论在冠状动脉多支血管病变患者中CCS与PCI预后有关,CCS>400提示较高的PCI并发症发生率。女性患者CCS越高PCI预后越差。

关键词(KeyWords)： 冠状动脉钙化积分;冠状动脉介入治疗;预后

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 何立芸,王方芳,韩江莉,米琳,许佳文,张福春,郭丽君,高炜

参考文献(References)：

• [1]Task Force on Myocardial Revascularization of the European Society of Cardiology,the European Association for Cardio-Thoracic Surgery,European Association for Percutaneous Cardiovascular Interventions,et al.Guidelines on myocardial revascularization.Eur J Cardiothorac Surg,2010,38:S1-S52.
• [2]Hillis LD,Smith PK,Anderson JL,et al.2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery:executive summary:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Circulation,2011,124:2610-2642.
• [3]Sianos G,Morel MA,Kappetein AP,et al.The Syntax Score:an angiographic tool grading the complexity of coronary artery disease.EuroIntervention,2005,1:219-227.
• [4]Rumberger JA,Simons DB,Fitzpatrick LA,et al.Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area.A histopathologic correlative study.Circulation,1995,92:2157-2162.
• [5]Polonsky TS,McClelland RL,Jorgensen NW,et al.Coronary artery calcium score and risk classification for coronary heart disease prediction.JAMA,2010,303:1610-1616.
• [6]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.
• [7]Greenland P,Bonow RO,Brundage BH,et al.ACCF/AHA 2007clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain:a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force(ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography)developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography.J Am Coll Cardiol,2007,49:378-402.
• [8]Mosseri M,Satler LF,Pichard AD,et al.Impact of vessel calcifi cation on outcomes after coronary stenting.Cardiovasc Revasc Med,2005,6:147-153.
• [9]O'Rourke RA,Brundage BH,Froelicher VF,et al.American College of Cardiology/American Heart Association Expert Consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease.Circulation,2000,102:126-140.
• [10]Vavuranakis M,Toutouzas K,Stefanadis C,et al.Stent deployment in calcified lesions:can we overcome calcific restraint with highpressure balloon inflations?Catheter Cardiovasc Interv,2001,52:164-172.
• [11]Virmani R,Farb A,Burke AP.Coronary angioplasty from the perspective of atherosclerotic plaque:morphologic predictors of immediate success and restenosis.Am Heart J,1994,127:163-179.
• [12]何榕,韩江莉,许佳文,等.钙化积分对冠状动脉介入治疗的稳定性冠心病患者的预测价值.中国介入心脏病学杂志,2011,19:2-6.
• [13]Bredlau CE,Roubin GS,Leimgruber PP,et al.In-hospital morbidity and mortality in patients undergoing elective coronary angioplasty.Circulation,1985,72:1044-1052.
• [14]Bangalore S,Vlachos HA,Selzer F,et al.Percutaneous coronary intervention of moderate to severe calcified coronary lesions:insights from the National Heart,Lung,and Blood Institute Dynamic Registry.Catheter Cardiovasc Interv,2011,77:22-28.
• [15]Mori S,Yasuda S,Kataoka Y,et al.Significant association of coronary artery calcifi cation in stent delivery route with restenosis after sirolimus-eluting stent implantation.Circ J,2009,73:1856-1863.
• [16]Lasala JM,Cox DA,Dobies D,et al.Drug-eluting stent thrombosis in routine clinical practice:two-year outcomes and predictors from the TAXUS ARRIVE registries.Circ Cardiovasc Interv,2009,2:285-293.
• [17]Brown AJ,McCormick LM,Gajendragadkar PR,et al.Initial Syntax Score Predicts Major Adverse Cardiac Events After Primary Percutaneous Coronary Intervention.Angiology,2013,Apr 9[Epub ahead of print].