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目的:评价高危斑块对冠状动脉(冠脉)轻中度狭窄胸痛患者的预测价值。方法:连续入选2014-01-2015-12因胸痛来我院行冠脉CT血管造影(CCTA)提示冠脉轻中度狭窄患者384例,入选患者通过CT检查检出低CT衰减、餐巾环征、正性重构、点状钙化等特征的高危斑块。患者根据高危斑块积分分为3组,0分组292例,1分组30例,≥2分组62例。第1、3、6及12个月时对入选患者进行随访,记录主要不良心脏事件(MACE)。结果:随访期间共发生76例心脏不良事件。总体不良事件及心源性死亡方面,≥2分组患者高于0分组(P<0.05)。Kaplan-Meier生存分析表明,0分组、1分组及≥2分组累积无事件生存率分别为83.2%、78.1%及60.0%,0分组显著高于≥2分组(χ~2=16.29,P<0.05)。COX回归分析表明,高危斑块积分≥2分对患者预后有显著影响(HR=3.447,95%CI:2.112~5.625,P<0.01)。结论:高危斑块是冠脉轻中度狭窄胸痛患者发生心脏不良事件的独立危险因素,尤其高危斑块积分≥2分与患者预后显著相关,高危斑块积分可尝试评价胸痛患者预后。
OBJECTIVE: To evaluate the predictive value of high-risk plaque in patients with mild to moderate coronary artery (coronary artery) stenosis. Methods: The consecutive 2014-01-2015-12 chest CT coronary angiography (CCTA) in our hospital prompted 384 patients with mild to moderate coronary artery stenosis, selected patients by CT examination detected low CT attenuation, napkin ring sign , Positive reconstruction, punctate calcification and other characteristics of high-risk plaque. According to the high risk plaque score, the patients were divided into 3 groups: 29 cases in 0 group, 30 cases in 1 group and 62 cases in ≥2 group. Patients were followed up at 1, 3, 6 and 12 months to record the major adverse cardiac event (MACE). RESULTS: A total of 76 cardiac events occurred during follow-up. In terms of overall adverse events and cardiac death, ≥2 patients in the group were higher than 0 (P <0.05). The Kaplan-Meier survival analysis showed that the cumulative event-free survival rates were 0%, 1% and 2% respectively, and the cumulative event-free survival rates were 83.2%, 78.1% and 60.0% in group 0, group 0 and group 2 ). COX regression analysis showed that the high-risk plaque score≥2 points had a significant effect on the prognosis (HR = 3.447, 95% CI: 2.112-5.625, P <0.01). Conclusion: High-risk plaque is an independent risk factor for cardiac adverse events in patients with moderate to severe coronary artery stenosis. Especially, the high-risk plaque score ≥2 points is significantly correlated with the prognosis of patients. High-risk plaque score may be used to evaluate the prognosis of patients with chest pain.