在接受非心脏手术的患者中进行术前心血管风险分层的CCTA和CACS:系统性审查和元分析
Ioannis Kyriakoulis1, Konstantinos G Kyriakoulis2, Konstantinos Aznaouridis3
1Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
Journal of cardiovascular computed tomography
|July 18, 2025
概括
冠状动脉计算机断层扫描血管学 (CCTA) 和冠状动脉评分 (CACS) 有效预测非心脏手术后的主要不良心血管事件 (MACE). 这些成像技术可靠地风险分层患者,改善手术前评估和结果.
科学领域:
- 心脏病学 心脏病学
- 放射学 放射学是一门学科.
- 心血管成像 - 心血管成像
背景情况:
- 主要不良心血管事件 (MACE) 是非心脏手术后发病率和死亡率的重要原因.
- 传统的手术前心血管风险分层依赖于心肌输液成像或应力心声图.
- 冠状动脉计算机断层扫描 (CCTA) 和冠状动脉评分 (CACS) 显示了MACE预测的预后价值.
研究的目的:
- 系统评估CCTA和CACS在预测非心脏手术患者的短期和长期MACE的预后价值.
- 评估CCTA和CACS用于MACE预测的诊断性能.
- 为了比较CCTA和CACS在心血管风险分层中的有效性.
主要方法:
- 在MEDLINE和Scopus中系统地搜索相关研究的文献.
- 使用随机效应模型估计MACE的聚合几率比率的元分析.
- 双变随机效应的元分析,以评估聚合的灵敏度和特异性;PPV,NPV和精度的比例的元分析.
主要成果:
- 在分析中包括了14项研究.
- 在CCTA上阻塞性狭窄 (≥50%) 显著增加了MACE几率 (短期OR:3.94,长期OR:8.95).
- 严重的CACS (≥400) 也增加了MACE的几率 (短期OR:2.29,长期OR:5.45).
- CCTA和CACS显示出高负预测值 (NPV),但中等的正预测值 (PPV).
结论:
- 在CCTA上阻塞性狭窄可靠地对MACE的患者进行风险分层.
- 严重的CACS (≥400) 也是非心脏手术患者风险分层的可靠指标.
- CCTA和CACS是术前心血管风险评估的宝贵工具.
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