| Background:In the methods for evaluating the degree of coronary artery disease in angina patients,coronary CT angiography(CCTA)is currently the preferred non-invasive imaging examination for diagnosing coronary heart disease.However,to accurately identify whether stenosis in the coronary artery leads to myocardial ischemia,functional testing results are required,specifically the blood flow reserve score measured by pressure guide wire during coronary angiography(CAG)and fractional flow reserve(FFR)measurements.However,both CAG and FFR measurements carry certain risks and increase the economic burden on patients due to their high level of technical proficiency and the use of specialized equipment.CTFFR is a non-invasive and simple technology that uses the 3D anatomical model of the coronary artery obtained by uploading images from CCTA to simulate the physiological state of the coronary artery and obtain corresponding functional assessment results for specific stenotic lesions.On top of this,CTFFR based on deep learning technology has shortened the time it takes to simulate the coronary artery model and made real-time CTFFR calculation possible at the work station,with proven accuracy in evaluating ischemic stenotic lesions,as recognized by domestic and international research.This technology has the potential to provide safer,more convenient,more economical,and more accurate diagnosis and treatment decisions for patients with stable angina.Objective:We are committed to comparing the clinical outcomes of using CCTA and CAG to guide the treatment of patients with initial stable angina pectoris who are admitted to the hospital,and exploring the possibility that CTFFR guided treatment based on deep learning is an accurate and reliable routine non-invasive detection method for patients with initial stable angina pectoris,which is more convenient and economical than CAG.Method:A total of 158 patients who were hospitalized in the Department of Cardiology,the Third Affiliated Hospital of Guangzhou Medical University from January 2018 to June 2022 for the first time due to angina were collected as the research subjects.Among them,79 cases underwent initial coronary angiography(CAG),and 79 cases underwent initial coronary CT angiography(CCTA).The Kowa deep vein score system was used to analyze the images of the 79 patients who completed the CCTA examination,and CTFFR was obtained.All patients hospitalized for the first time due to angina were initially divided into the CAG group(79 cases)and the CCTA group(79 cases).The study endpoint was defined as hospitalization again due to angina and receiving coronary revascularization treatment.(1)Analyze the differences in general information,auxiliary examination results,and post-discharge medication treatment between the two groups of patients;(2)Compare the differences in hospitalization time and interval hospitalization time between the CAG group and the CCTA group,as well as the incidence of hospitalization due to angina recurrence and receiving coronary revascularization treatment within 12 and 24 months.(3)Based on the CTFFR results obtained from the CCTA images analysis of the CCTA group,further divide the vessels into two groups according to the severity of the lesion:≤0.8 and>0.8,and analyze the composition distribution of vascular dysfunction within different stenosis grades.Compare it with the CAG group,compare the differences in hospitalization time and interval hospitalization time between the groups,as well as the incidence of hospitalization due to angina recurrence and receiving coronary revascularization treatment within 12 and 24 months.(4)Compare the differences in costs between the CAG group and the CCTA group during hospitalization.Results:(1)The general information of the two groups of patients in this study has the characteristics of baseline consistency,such as age,gender,smoking history,history of hypertension,history of diabetes,blood lipid abnormalities,severity of angina,post-discharge medication treatment plan,etc.The results showed no significant statistical differences in general information between the two groups(P≥0.05);however,there was a significant difference in the cost during hospitalization between the two groups(P<0.01),with the hospitalization cost of the CAG group significantly higher than that of the CCTA group(18235.75 yuan vs 12800.04 yuan).(2)In the endpoint event of hospitalization due to angina recurrence,the CAG group had 28 cases(35.4%)rehospitalized within 12 months,while the CCTA group had 23 cases(29.1%).According to the Kaplan-Meier survival analysis,there was a certain difference in the median survival time within 12 months between the CAG group and the CCTA group(216 vs 225,P=0.331),but the difference was not statistically significant.(3)There were differences between the CAG group and the CCTA group in mild stenosis and moderate stenosis,with 41(39.5%)vs 94(73.4%)[95%CI(0.137-0.417),P<0.001];56(54.4%)vs 29(22.7%)[95%CI 0.184-0.758,P<0.001],respectively.There was no statistically significant difference between the two groups in severe stenosis(P>0.05).(4)Using the deep venous system to calculate CTFFR values for each CCTA group patient,Kaplan-Meier survival analysis was performed.Within 12 months,there were 9 patients receiving coronary revascularization treatment in the CAG group(32.1%),6 patients in the≤0.8 group(75.0%),and 7 patients in the>0.8 group(46.7%).The difference between the CAG group and the ≤0.8 group was statistically significant(P=0.030),but there was no statistically significant difference between the CAG group and the>0.8 group(P=0.384).Within 24 months,there were 22 patients receiving coronary revascularization treatment in the CAG group(36.6%),9 patients in the ≤0.8 group(64.3%),and 21 patients in the>0.8 group(50.0%).The difference between the CAG group and the ≤0.8 group was statistically significant(P=0.041),but there was no statistically significant difference between the CAG group and the>0.8 group(P=0.180).(5)In further multivariate Cox regression analysis,the results showed that the CTFFR results had a statistically significant impact on whether patients needed coronary revascularization treatment within 12 months(HR=3.690,95%CI 1.019-3.361,P=0.047).Conclusions:In patients with initial angina pectoris,the evaluation of coronary artery disease using CCTA combined with CTFFR is not inferior to CAG in guiding treatment prognosis and can reduce the economic burden on patients. |
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