| Objective: To investigate the long-term prognosis and related risk factors of coronary artery new-plaque and cardiovascular events in patients with suspected coronary heart disease with normal coronary artery CT,and to avoid unnecessary repeated coronary artery CT examinations in such patients in a short period of time,and some methods should be carried out to avoid adverse cardiovascular events,especially in patients with those high risk factors.Materials and Methods: Patients with suspected coronary artery disease were retrospectively enrolled from June 2006 to July 2017,all patients(including outpatients and in-patients)have two or more consecutive coronary artery CT examinations(baseline coronary artery CT is normal,at least one coronary artery CT re-examination).Baseline and follow-up coronary artery CT were normally defined as group A,while normalbaseline coronary artery CT and positivefollow-up(new coronary plaque in follow-up coronary artery CT)was defined as group B.The plaque and degree of stenosis in coronary segments with a diameter >1.5 mm were evaluated by 2independent radiologists with more than 10 years of experience,who were double blinded for this study.Any disagreement was resolved by consensus after a combined evaluation that included a third radiologist.The clinical endpoint of this study was Cardiovascular events,including,myocardial infarction,heart failure,revascularization and cardiogenic death.Results: A total of 332 patients were included in the study,consisted of 135 men and197 women,aged 52.3 to 76.6 years(59.2±11.6 years).The average follow-up time ofCT is 5.6 ± 0.5 years(3.8-7.2 years),the average follow-up time of clinical is 9.8±0.6 years(6.6 to 12.6 years).304 in group A and 28 in group B.(1)Group A consisted of119 men and 185 women,aged 6.6 to 12.6 years(58.3 ±11.5 years),accounting for91.6% of all the research object.The average follow-up time of CT is 5.2±0.5 years(3.6-6.7 years),the average follow-up time of clinical is 9.8±0.7 years(7.6-12.3 years),0 patient suffer from cardiovascular events.Group B consisted of 16 men and 12 women,aged 62.6±11.4 years(55.6-72.3 years),accounting for 8.4% of all the research object.The average follow-up time of CT is 6.5 ±0.6(4.6-7.7years),the average follow-up time of clinical is 9.6±0.9years(7.6-11.8 years),2 patients suffer from cardiovascular events(both for cardiac death),accounting for 7.1% of the group B patients,and 0.6% of the total patients(group A + B).The body mass index,age,family history of coronary heart disease,hyperlipidemia and diabetes between the two groups were statistically difference(P < 0.05),smoking history,hypertension and hyperlipidemia were significantstatistically differences(P < 0.01).(2)A total of 34 coronary artery new plaques were found in 28 patients in group B,and the plaques were mainly located in the left anterior descending branch(15,44.1%)and the right coronary artery(15,44.1%).The number of <50%stenosis of coronary artery are 32(94.1%),the number of? 50%stenosis of coronary artery are 2(5.9%).(3)Logistic multivariate regression analysis was performed using known risk factors(age,coronary heart disease,family history,body mass index,hyperlipidemia,diabetes,smoking,hypertension,and hyperlipidemia)as covariables,the results showed that smoking(OR:2.367,95%CI:1.452-3.67,P<0.01),hypertension(OR:2.317,95%CI: 1.352-3.57,P<0.01),hyperlipidemia(OR:2.327,95%CI:1.362~3.67,P<0.01)was the independent risk factors for patients with normal baselinecoronary CT and positive follow-up.Conclusion: The patients with normal baseline coronary artery CT have a good long-term prognosis among the patients with suspected coronary heart disease.The average incidence of cardiovascular events is only 0.6% in 9.8 years,and no repeated coronary artery CT examination is needed in 6.5 years.We should pay attention to the patients with normal baseline coronary artery CT while positive follow-up,especiallythose with risk factors such as smoking,hypertension and hyperlipidemia.The progression of coronary artery plaque andadverse cardiovascular events can be delayed or prevented by early clinical intervention. |
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