| ObjectiveThe aim was to assess the prognostic value of computed tomography coronaryangiography and coronary artery calcium scoring in patients which were doubted coronaryartery disease.Materials and MethodsThe prospective study included of150patients (male Female=7971, the average ageis60.27±9.78, the age range is34-82).320-row dynamic volume computed tomographieswere undergone by all patients. The results of computed tomography coronary angiographyand coronary artery calcium scoring were prospectively analyzed. Patients with suspectedcoronary artery disease underwent320-row dynamic volume computed tomography forfollowing indications:(1) symptoms of chest pain and breathing difficulties (2) risk factorsof coronary artery disease (3) cardiac ultrasound examination revealed local motionabnormalities. The dangerous elements were cassetted, involving age, sex, value of bloodpressure, value of blood lipids, value of blood glucose, history of smoking, family historyand whether obesity [(when the body mass index (BMI)>24kg/m2considered obese. Allpatients were followed up by querying hospitalization data, the regular outpatientfollow-up and telephone contact. Followed-up was completed every month. Controldropout rate. Patients which included of the cardiac death, unstable angina, myocardialinfarction and hospitalization which require to coronary artery bypass grafting andpercutaneous coronary intervention were followed up. The first time of the heart event wasno free survival time. The event-free survival difference of CTCA and CACS werecompared by using Kaplan-Meier survival curves.The univariate and multivariate COXregression analysis was applied to compare the prognostic value of CTCA and CACS. ResultsNonsignificant CAD was detected in85patients, significant CAD in38patients andabsence of CAD in27patients. Calcified plaque was discovered in28patients, noncalcifiedplaque was discovered in32patients, mixed plaque was discovered in63patients. CACS0to10was discovered in54patients,11to400in47patients and CACS>400in49patients.The average follow-up of study was (22±6) months.17patients have occurredendpoint events which cardiac death was occurred in3cases, acute myocardial infarctionwas occurred in7cases, unstable angina was occurred in4cases, patients was undergocoronary revascularization in3cases.Patients which CTCA examination was normal wereno endpoint events, Kaplan-Meier survival analysis demonstracted that the cumulativeevent-free survival rates of nonobstructive and obstructive coronary artery were92.9%and71.1%, the two groups have significant difference (χ2=10.791, P=0.001).The cumulativeno event survival rates of the calcified plaques, no calcified plaque and mixed plaque were96.4%,93.8%and77.8%, in which CTCA was showed.There were significant differencebetween the three groups(χ2=7.995, P=0.018). Kaplan-Meier survival analysisdemonstracted that the rates of cumulative eventfree survival in the CACS0-10,CACS11-400and CACS>400were98.1%,89.4%and77.6%, there were significant differencebetween the three groups(χ2=10.699, P=0.005).The univariate COX regression analysisdemonstracted the extent of stenosis, components of plaques and calcium scoring wererecognized as risk factors of heart events(OR=5.254,95%CI=2.095-13.176, P<0.001;OR=6.877,95%CI=1.372-14.033,P<0.001;OR=2.976,95%CI=1.437-6.614,P=0.003).However, the extent of stenosis and components of plaques which the multivariate COXregression analysis was demonstracted were significant factors for prognosis ofpatients(OR=3.725,95%CI=1.379-10.062,P=0.007;OR=4.283,95%CI=1.992-12.254,P=0.002).ConclusionsFor patients which were doubted coronary artery disease(CAD), CTCA and CACShave effective predictive value for heart events. Moreover, the CTCA is more effectivethan CACS to predict heart events. |
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