摘要
目的 评价冠状动脉CT造影（CCTA）用于中、高危险度非心脏手术术前排除冠心病,避免无必要侵袭性冠状动脉造影（ICA）的价值.方法 选取解放军总医院2013年1月至6月拟行中、高危险度非心脏手术、需要术前行ICA的患者157例,其中高危险度手术17例,中危险度手术140例.采用多排螺旋CT行术前CCTA.术后随访6～11个月,观察心血管事件发生情况,包括急性冠状动脉综合征及继发于急性冠状动脉综合征的死亡、心律失常、冠状动脉血管重建及心力衰竭.比较非心脏手术前未行ICA的患者和行ICA的患者术后心血管事件的发生率.结果 157例患者中,145例（92.4％）的CCTA图像可用于诊断冠心病,其中37例无冠状动脉粥样硬化,88例有冠状动脉粥样硬化但管腔狭窄＜50％,此125例患者术前未再行ICA检查;经术前手术风险评估,118例按期手术,7例经内科治疗后择期手术.CCTA显示20例有冠状动脉粥样硬化且管腔狭窄≥50％,于CCTA后3～7d内进行了ICA检查,其中18例确诊.根据CCTA及ICA结果,经术前手术风险评估,11例患者按期手术,9例在冠状动脉粥样硬化得到干预后再行手术.CCTA所示血管狭窄程度对手术计划的影响有统计学意义（P＜0.0001）.12例患者的CCTA图像不可用于诊断,术前进行了ICA检查,其中4例显示为管腔狭窄≥50％的冠状动脉粥样硬化.在非心脏手术前未行ICA的患者和行ICA的患者比较,术后心血管事件的发生率差异无统计学意义（P=0.45）.结论 拟行中、高危险度非心脏手术的患者术前行CCTA可有效诊断冠心病.CCTA表现正常或管腔狭窄＜50％的患者术前可免除ICA检查.
Objective To assess the value of preoperative coronary computed tomographic angiography （CCTA） in the detection of coronary artery disease （CAD） in patients planned to undergo non-cardiac surgery at intermediate or high risk to avoid unnecessary invasive coronary angiography （ICA）.Methods The study protocol was approved by our institutional review board and informed consent was given.In this prospective study,157 consecutive patients who underwent CCTA before undergoing non-cardiac surgery at intermediate or high risk was involved.The non-cardiac surgery included high-risk surgery （17 patients） and intermediate-risk surgery （140 patients）.Follow-up was performed in 6-11 months to define cardiac events described as acute coronary syndrome （ACS） or death secondary to ASC,arrhythmias,cardiac revascularization,or cardiac failure.x2 test was performed to compare the differences in incidence of cardiac events among patients who had undergone or who had not undergone preoperative ICA.Results CCTA was of diagnostic value in 145 of 157 patients.Thirty-seven of 145 had no CAD,and 88 of 145 had no significant CAD （＜50％ stenosis）,and non-cardiac surgery was performed in them without preoperative ICA.No patients in those patients had postoperative ischemic events at follow-up; 20 had significant CAD （≥50％ stenosis） and underwent surgery after preoperative ICA.CCTA was non-diagnostic in 12 patients who were referred for preoperative ICA,and 4 of 12 underwent surgery after PCI or CABG.There were no differences in cardiac events between patients who had undergone preoperative ICA and those who had not （P =0.45）.Conclusions In patients with planned non-cardiac surgery at medium or high risk of cardiovascular events,preoperative CCTA is an effective diagnostic tool for detecting CAD.Preoperative ICA can be safely avoided in patients with normal findings or with stenosis ＜50％ in CCTA.
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2014年第3期255-260,共6页
Acta Academiae Medicinae Sinicae
基金
国家自然科学基金(81371547)~~
关键词
多排螺旋CT冠状动脉造影
非心脏手术
术前
冠心病
侵袭性冠状动脉造影
心血管事件
multi-slice spiral coronary computed tomography angiography
non-cardiac surgery
preoperative
coronary artery disease
invasive coronary angiography
cardiovascular events
