JAMA Intern Med:国内冠状动脉狭窄严重程度诊断准确性有待提升

2018-01-17 zhangfan MedSci原创

研究发现,对于接受PCI治疗的中国冠状动脉病变患者,医师视觉评估对动脉狭窄严重程度的评估普遍高于冠脉造影定量分析,其差异随不同医院和医生的变化而变化,提高中国冠状动脉狭窄严重程度诊断的准确性十分必要

目前,医师视觉评估(PVA)是中国冠状动脉狭窄严重程度以及是否进行冠状动脉血管重建的主要临床标准,但其准确性仍存在一定质疑。近日研究人员在经皮冠状动脉介入患者中比较了PVA与冠脉造影定量分析(QCA)对冠状动脉狭窄严重程度评估的差异。

研究招募了1295名PCI患者,在中国18个省,35个医疗中心开展。研究的主要终点是PVA与 QCA对病变狭窄程度评估差异,根据急性心肌梗死(AMI)对患者进行分层。

非AMI患者平均年龄62岁,31.5%为女性,而AMI患者平均年龄60岁,女性占25.2%。研究发现,对于非AMI患者,PVA诊断的狭窄直径百分比较QCA高16.0%,对于AMI患者高10.2%。对于非AMI患者,PVA诊断837人存在70%及以上狭窄,而QCA诊断427人(50.6%)狭窄小于70%;AMI患者也表现出类似的结果。在30个参与研究的医院中,对于非AMI患者,PVA与 QCA对狭窄严重程度的评估差异为7.6%-21.3%,57名临床医师,差异为6.9%-26.4%。

研究发现,对于接受PCI治疗的中国冠状动脉病变患者,医师视觉评估对动脉狭窄严重程度的评估普遍高于冠脉造影定量分析,其差异随不同医院和医生的变化而变化,提高中国冠状动脉狭窄严重程度诊断的准确性十分必要。

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