冠状动脉分数改善了低风险组的症状患者的风险评估,基于目前的指南
Chengjian Wang1, Xiaomeng Zhang2, Chang Liu3
1Department of Cardiology, Tianjin Chest Hospital, 300222 Tianjin, China.
冠状动脉评分 (CACS) 有效地识别显著的冠状动脉疾病 (CAD),并预测低风险的患者与稳定的胸痛 (SCP) 主要不良心血管事件 (MACE). 这有助于改进风险评估,超出最初的概率估计.
科学领域:
- 心脏病学 心脏病学
- 放射学 放射学是一门学科.
- 预防医学 预防医学
背景情况:
- 目前关于稳定胸痛 (SCP) 的指导方针建议使用ESC-PTP模型估计预测概率 (PTP).
- 根据2021年指南的定义,对于低风险患者 (ESC-PTP <15%) 需要进一步进行风险分层.
- 在这个人群中,冠状动脉评分 (CACS) 的诊断和预后值需要全面的调查.
研究的目的:
- 评估CACS在识别低风险SCP患者冠状动脉疾病 (CAD) 的诊断准确性.
- 评估CACS在预测主要心血管不良事件 (MACE) 中的预后价值.
- 确定CACS对细化低估PTP患者的风险评估的有用性.
主要方法:
- 招募了8265名使用CACS和冠状动脉计算机断层扫描血管学 (CCTA) 评估SCP的患者.
- 使用ESC-PTP模型估计PTP;包括5183名ESC-PTP<15%的患者进行分析.
- 在MACE和侵入性手术中跟踪患者,使用Cox和后勤回归模型分析CAD严重程度和CACS关联.
主要成果:
- 在5183名低风险患者中,1.6%的患者在4年内经历了MACE.
- 较高的CACS与阻塞性CAD的患病率增加显著相关 (p < 0.0001).
- 升高的CACS与更高的MACE风险 (调整后HRs高达13.47) 和侵入性手术利用率的增加有关.
结论:
- 高CACS在低风险患者中确定了显著的CAD和临床终点,即使是那些推推迟测试的患者.
- CACS作为一种有价值的工具,用于进一步评估稳定胸痛患者的低PTP的风险.
- 这些发现支持将CACS纳入临床管理策略,以改善患者的治疗结果.
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