JACC:冠状动脉左主干疾病的预测因素有哪些?

2022-02-19 MedSci原创 MedSci原创

在中度或重度缺血患者中,临床和压力测试参数对CTA上的LMD有中等预测作用。

冠状动脉疾病(coronary artery disease,CAD)是指冠状动脉血流减少所致的心脏病,最常见病因为动脉粥样硬化。临床表现包括无症状性心肌缺血, 心绞痛, 急性冠脉综合征 (不稳定性心绞痛, 心肌梗死),心源性猝死。

CAD诊断主要依据症状、心电图及负荷试验,有时需结合冠脉造影。预防主要通过改变可逆性危险因素(如血脂异常、高血压、体力活动缺乏、肥胖、糖尿病和吸烟)。治疗包括各类药物及非药物手段,以减少心肌缺血、恢复或改善冠脉血流。

在所有接受冠状动脉造影的患者中,有4%-6%的患者存在严重的冠状动脉左主干病变(LMCAD),严重定义为冠状动脉造影显示狭窄超过50%。大约70%的LMCAD患者同时合并冠状动脉多支病变。

检测直径≥50%的狭窄左主冠状动脉疾病(LMD)具有预后和治疗的意义。无创压力成像或运动耐力测试(ETT)是检测阻塞性冠状动脉疾病的最常用方法,但LMD的压力测试标志物仍未确定。

为了利用临床和压力测试参数,确定在冠状动脉计算机断层扫描(CTA)上检测到的LMD的标志物,来自英国诺斯威克公园医院-皇家布朗普顿医院的专家开展了相关研究,结果发表在JACC杂志上。

这是对ISCHEMIA(医疗和侵入性方法的健康效果比较国际研究)的事后分析,包括随机和非随机参与者,他们在非成像ETT、应激核心肌灌注成像或应激超声心动图后的CTA排除了LMD的局部确定中度或重度缺血。之前有CABG术病史的患者被排除在外。

在5146名参与者中(平均年龄63岁,74%为男性),414人(8%)患有LMD。LMD的预测因素是年龄较大(P < 0.001),男性(P < 0.01),以前没有心肌梗死(P < 0.009),压力超声心动图上左心室的短暂缺血性扩张(P = 0.05),ETT上ST段压低的程度(P = 0.004),以及ETT上达到的代谢峰值当量(P = 0.001)。这些模型对LMD的预测作用一般(C-index 0.643和0.684)。

在中度或重度缺血患者中,临床和压力测试参数对CTA上的LMD有中等预测作用。对于大多数中度或重度缺血的患者,需要通过解剖学成像来排除LMD。

 

参考文献:

Predictors of Left Main Coronary Artery Disease in the ISCHEMIA Trial. J Am Coll Cardiol. 2022 Feb, 79 (7) 651–661

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1718551, encodeId=77dd1e18551e5, content=<a href='/topic/show?id=35534e966a0' target=_blank style='color:#2F92EE;'>#左主干#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47966, encryptionId=35534e966a0, topicName=左主干)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e5fa32580320, createdName=cathymary, createdTime=Wed May 18 11:28:00 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1855038, encodeId=c02218550388f, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Sat Apr 02 16:28:00 CST 2022, time=2022-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264394, encodeId=79f31264394d3, content=<a href='/topic/show?id=daf1100226fb' target=_blank style='color:#2F92EE;'>#预测因素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100226, encryptionId=daf1100226fb, topicName=预测因素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a57b78, createdName=朱睿睿, createdTime=Mon Feb 21 10:28:00 CST 2022, time=2022-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326913, encodeId=acf613269137c, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Mon Feb 21 10:28:00 CST 2022, time=2022-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1195554, encodeId=5acb11955542e, content=一篇好文章,确实受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=07b66513614, createdName=ms1000000037522342, createdTime=Mon Feb 21 08:35:39 CST 2022, time=2022-02-21, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1718551, encodeId=77dd1e18551e5, content=<a href='/topic/show?id=35534e966a0' target=_blank style='color:#2F92EE;'>#左主干#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47966, encryptionId=35534e966a0, topicName=左主干)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e5fa32580320, createdName=cathymary, createdTime=Wed May 18 11:28:00 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1855038, encodeId=c02218550388f, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Sat Apr 02 16:28:00 CST 2022, time=2022-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264394, encodeId=79f31264394d3, content=<a href='/topic/show?id=daf1100226fb' target=_blank style='color:#2F92EE;'>#预测因素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100226, encryptionId=daf1100226fb, topicName=预测因素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a57b78, createdName=朱睿睿, createdTime=Mon Feb 21 10:28:00 CST 2022, time=2022-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326913, encodeId=acf613269137c, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Mon Feb 21 10:28:00 CST 2022, time=2022-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1195554, encodeId=5acb11955542e, content=一篇好文章,确实受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=07b66513614, createdName=ms1000000037522342, createdTime=Mon Feb 21 08:35:39 CST 2022, time=2022-02-21, status=1, ipAttribution=)]
    2022-04-02 hbwxf
  3. [GetPortalCommentsPageByObjectIdResponse(id=1718551, encodeId=77dd1e18551e5, content=<a href='/topic/show?id=35534e966a0' target=_blank style='color:#2F92EE;'>#左主干#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47966, encryptionId=35534e966a0, topicName=左主干)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e5fa32580320, createdName=cathymary, createdTime=Wed May 18 11:28:00 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1855038, encodeId=c02218550388f, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Sat Apr 02 16:28:00 CST 2022, time=2022-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264394, encodeId=79f31264394d3, content=<a href='/topic/show?id=daf1100226fb' target=_blank style='color:#2F92EE;'>#预测因素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100226, encryptionId=daf1100226fb, topicName=预测因素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a57b78, createdName=朱睿睿, createdTime=Mon Feb 21 10:28:00 CST 2022, time=2022-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326913, encodeId=acf613269137c, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Mon Feb 21 10:28:00 CST 2022, time=2022-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1195554, encodeId=5acb11955542e, content=一篇好文章,确实受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=07b66513614, createdName=ms1000000037522342, createdTime=Mon Feb 21 08:35:39 CST 2022, time=2022-02-21, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1718551, encodeId=77dd1e18551e5, content=<a href='/topic/show?id=35534e966a0' target=_blank style='color:#2F92EE;'>#左主干#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47966, encryptionId=35534e966a0, topicName=左主干)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e5fa32580320, createdName=cathymary, createdTime=Wed May 18 11:28:00 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1855038, encodeId=c02218550388f, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Sat Apr 02 16:28:00 CST 2022, time=2022-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264394, encodeId=79f31264394d3, content=<a href='/topic/show?id=daf1100226fb' target=_blank style='color:#2F92EE;'>#预测因素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100226, encryptionId=daf1100226fb, topicName=预测因素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a57b78, createdName=朱睿睿, createdTime=Mon Feb 21 10:28:00 CST 2022, time=2022-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326913, encodeId=acf613269137c, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Mon Feb 21 10:28:00 CST 2022, time=2022-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1195554, encodeId=5acb11955542e, content=一篇好文章,确实受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=07b66513614, createdName=ms1000000037522342, createdTime=Mon Feb 21 08:35:39 CST 2022, time=2022-02-21, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1718551, encodeId=77dd1e18551e5, content=<a href='/topic/show?id=35534e966a0' target=_blank style='color:#2F92EE;'>#左主干#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47966, encryptionId=35534e966a0, topicName=左主干)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e5fa32580320, createdName=cathymary, createdTime=Wed May 18 11:28:00 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1855038, encodeId=c02218550388f, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Sat Apr 02 16:28:00 CST 2022, time=2022-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264394, encodeId=79f31264394d3, content=<a href='/topic/show?id=daf1100226fb' target=_blank style='color:#2F92EE;'>#预测因素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100226, encryptionId=daf1100226fb, topicName=预测因素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a57b78, createdName=朱睿睿, createdTime=Mon Feb 21 10:28:00 CST 2022, time=2022-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326913, encodeId=acf613269137c, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Mon Feb 21 10:28:00 CST 2022, time=2022-02-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1195554, encodeId=5acb11955542e, content=一篇好文章,确实受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=07b66513614, createdName=ms1000000037522342, createdTime=Mon Feb 21 08:35:39 CST 2022, time=2022-02-21, status=1, ipAttribution=)]
    2022-02-21 ms1000000037522342

    一篇好文章,确实受益匪浅

    0

相关资讯

代谢综合征或胰岛素抵抗怎么就找上我!还是我胃里的“小东西”带的路?

Diabetol Metab Syndr.:幽门螺杆菌感染与代谢综合征和胰岛素抵抗风险的关系:一项最新的系统回顾和荟萃分析

这些疼痛可能是心绞痛,要当心!

研究显示约80%以上的冠心病患者在治疗后仍存在心绞痛的症状,严重影响他们的生存质量。

J Clin Lipidol:在接受他汀类药物治疗的冠心病患者中,较低的LDL-C水平与较低的薄纤维帽粥样斑块发生率相关

近日,发表在《J Clin Lipidol》的一篇研究显示:在他汀类药物治疗的冠状动脉疾病(CAD)患者中,较低的LDL-C水平与罪犯斑块中的薄纤维帽粥样斑块(TCFAs)的较低发生率相关。

AHJ:无症状冠心病植入支架预后如何?研究

COURAGE和ISCHIMA研究提示稳定型冠心病患者与最佳药物治疗相比,血运重建能减轻症状,但不能降低死亡率。那么没有症状的稳定型缺血性心脏病 (SIHD) 患者行PCI治疗预后如何?

Circulation:做好简单生活7法则,“逆天改命”不是梦!可增加无冠心病年数高达20年!

Circulation:美国心脏协会的简单生活7法则:生活方式建议,多基因风险和冠心病的终生风险

JAMA子刊:教你吃得身体倍儿棒!15种食物有益心血管健康,10种有害千万少吃,防糖尿病更有效的竟然是酸奶!

JAMA Network Open:本研究确定了15种具有保护性关联的饮食因素和10种具有有害关联的饮食因素,并确定了特定CMD终点。

拓展阅读

TCT2018:MAIN-CompPARE研究:治疗无保护左主干病变,介入和搭桥10年效果相当

根据TCT 2018发布的MAIN-CompPARE研究数据,接受PCI治疗的左主干病变患者与接受CABG治疗的患者相比,在10年内具有相似的死亡率和临床预后,但PCI 的靶血管再血管化率更高。

TCT@CIT联合论坛:重要、极难、最热的话题

美国经导管心血管治疗学术会议(TCT2015)专题报道 当地时间10月11日18:30,具有浓厚中国色彩的TCT@CIT联合论坛拉开序幕。虽然当天的会议日程大多已结束,但芳草地艺术中心North会场仍座无虚席,论坛由高润霖院士、韩雅玲院士、杨跃进教授、徐波教授、乔树宾教授等主持,外方嘉宾也是“大腕”云集,TCT大会主席里昂(Leon)教授、美国著名心血管专家斯通(Stone)教授、马

EuroPCR 2015:[高润霖院士]阜外介入治疗左主干病变三年死亡率仅4.2%

5月19-22日,欧洲血运重建大会(EuroPCR)在法国巴黎隆重召开,全球1.2万名学者及医生云集在此,共享这一全球介入盛会。高润霖院士在大会上介绍了阜外心血管病医院左主干病变PCI治疗的3年随访结果。 高院士指出,PCI治疗左主干病变具有较低的支架内血栓形成、血运重建和死亡发生率,但应避免用于SYTAX评分>32分的患者。而且,术者经验对临床预后有很大影响,应给予高度重视。 该研究纳