基于CAD-RADS的高危斑块特征联合CT-FFR对冠状动脉临界病变预后的预测价值
Prognostic value of CAD-RADS-based high-risk plaque features combined with CT-FFR in intermediate coronary stenosis
赵建春 1龚沈初 2张凡 1王司晔3
作者信息
- 1. 南通市通州区人民医院影像科,江苏 226300
- 2. 南通大学第二附属医院影像科
- 3. 南通大学附属医院康复医学科
- 折叠
摘要
目的:研究基于冠状动脉疾病报告和数据系统(coronary artery disease-reporting and data system,CAD-RADS)的高危斑块特征联合CT血流储备分数(fractional flow reserve derived from CT,CT-FFR)对冠状动脉病临界病变患者预后的临床应用价值.方法:在CAD-RADS结构式报告基础上,前瞻性研究冠状动脉CT血管造影(coronary artery CT angiog-raphy,CCTA)影像资料和临床资料,共301例临界病变患者纳入研究,影像观察指标包括CAD-RADS≥3、钙化积分≥100、斑块易损性特征、高危斑块、长病变、CT-FFR≤0.8,观察指标的组合包括CAD-RADS≥3 V、CAD-RADS≥3 V且CT-FFR≤0.8.研究终点为预后不良,包括主要不良心血管事件(major adverse cardiovascular events,MACE)及计划外有创冠状动脉造影(invasive coronary angiography,ICA)、血运重建手术,研究样本分为预后良好组和预后不良组.通过统计不同组间数据的差异,评价CAD-RADS高危斑块联合CT-FFR对临界病变患者预后的临床价值.结果:年龄、钙化积分、CAD-RADS类别、斑块易损性特征、高危斑块、长病变、CT-FFR在预后良好组和预后不良组间的差异有统计学意义(P＜0.05);CAD-RADS类别、高危斑块、CT-FFR是冠状动脉临界病变预后的独立预测因子(P＜0.05);CT-FFR ≤0.8在CAD-RADS≥3组、钙化积分≥100组、不同斑块易损性特征组、高危斑块组、长病变组中发生率差异均有统计学意义(均P＜0.05);观察指标组合(CAD-RADS≥3 V且CT-FFR≤0.8)预测预后不良的特异性、准确性和阳性预测值分别为97.2％、85.7％、88.7％,AUC为0.795(95％CI:0.731～0.858).结论:基于CAD-RADS的高危斑块特征联合CT-FFR能有效预测MACE及计划外ICA、血运重建手术,指导临床针对性干预与治疗.
Abstract
Objective:To study the clinical value of coronary artery disease-reporting and data system(CAD-RADS)-based high-risk plaque features combined with fractional flow reserve derived from CT(CT-FFR)in the prognosis of patients with intermediate coronary stenosis.Methods:Based on the CAD-RADS structural reporting,the coronary artery CT angiography(CCTA)imaging and clinical data were prospectively studied,a total of 301 cases with intermediate coronary stenosis were included in the study.Imaging observation indicators include CAD-RADS≥3,agatston score≥ 100,plaque vulnerability fea-tures,high-risk plaques,long lesions,CT-FFR≤i0.8.The combination of observation indicators includes CAD-RADS ≥3 V,CAD-RADS ≥ 3 V and CT-FFR ≤0.8.The end point of the study was poor prognosis,including major adverse cardiovascular events(MACE)and unplanned invasive coronary angiography(ICA),stent implantation,and coronary artery bypass grafting.The study samples were divided into two groups:good prognosis group and poor prognosis group.To evaluate the clinical value of CAD-RADS high-risk plaque combined with CT-FFR in the prognosis of patients with intermediate coronary stenosis by counting the differences of data between different groups.Results:There were significant differences in age,calcification score,CAD-RADS class,plaque vulnerability,high-risk plaque,long lesion,good CT-FFR prognosis group and poor progno-sis group(P＜0.05).CAD-RADS class,high-risk plaque and CT-FFR were independent predictors of prognosis of intermediate coronary stenosis(P＜0.05).The incidence of CT-FFR ≤ 0.8 was significantly different in CAD-RADS ≥ 3 group,calcification score≥100 group,different plaque vulnerability group,high-risk plaque group and long-term disease group(P＜0.05).The specificity,accuracy,positive predictive value of the combination of observation indicators(CAD-RADS ≥ 3 V and CT-FFR≤0.8)for predicting poor prognosis were 97.2％,85.7％and 88.7％,and the AUC value was 0.795(95％CI:0.731-0.858).Conclusion:CAD-RADS-based high-risk plaque features combined with CT-FFR can effectively predict MACE and unplanned ICA,stent implantation and coronary artery bypass grafting,and guide clinical intervention and treatment.
关键词
冠状动脉临界病变/冠状动脉CT血管造影/冠状动脉疾病报告和数据系统/高危斑块/斑块易损性/CT血流储备分数Key words
intermediate coronary stenosis/coronary artery computed tomography angiography/coronary artery disease-reporting and data system/high-risk plaque/vulnerable plaque features/fractional flow reserve derived from computed tomography引用本文复制引用
基金项目
南通市卫生健康委科研立项项目(QA2021066)
出版年
2024
NETL
NSTL
万方数据