冠状动脉计算机断层血管造影与指南推荐的他汀类药物在疑似冠状动脉疾病门诊患者分配的临床风险评估

IF 4.3 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology Pub Date : 2025-04-22 DOI:10.1016/j.ajpc.2025.100995

Jianan Zheng , Zhihui Hou , Yang Gao , Weihua Yin , Yanan Ma , Yunqiang An , Yang Wang , Lei Song , Bin Lu

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引用次数: 0

摘要

目的：本研究的目的是比较冠状动脉计算机断层血管造影（CCTA）和指南推荐的临床风险评估在门诊疑似冠状动脉疾病（CAD）患者中他汀类药物分配的价值。方法7860例门诊疑似CAD患者行CCTA检查，通过指南推荐的临床风险评估和CCTA对硬动脉粥样硬化性心血管疾病（ASCVD）和主要心脑血管不良事件（MACCE）进行分层。对于中危患者，我们也比较了CCTA和CAC的预测价值。结果在3.6年的中位随访期间，共发生83例（1.1%）硬性ASCVD和170例（2.2%）MACCE。事件发生率随他汀类药物推荐强度（例如，硬ASCVD：不推荐的他汀类药物1.5 / 1000人年[PY]，中等强度他汀类药物4.1 / 1000人年[PY]，高强度他汀类药物8.9 / 1000人年）和冠状动脉狭窄严重程度（例如，硬ASCVD：无斑块者0.7 / 1000人年，非阻塞性CAD者5.1 / 1000人年，阻塞性CAD者11.2 / 1000人年）而增加。当CCTA分层时，对于硬ASCVD和MACCE，更高强度的他汀类药物推荐并不是统计学上显著的独立危险因素。对于中危患者硬性ASCVD的预测价值，CCTA与CAC的差异无统计学意义(受试者工作特征曲线下面积：0.692 vs 0.702；P = 0.78)。结论在接受CCTA的门诊患者中，sccta在他汀类药物的分配中比指南推荐的临床风险评估发挥更重要的作用。

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Coronary computed tomography angiography versus guideline-recommended clinical risk assessment for statin allocation in outpatients with suspected coronary artery disease

Aims

The purpose of this study was to compare coronary computed tomography angiography (CCTA) and guideline-recommended clinical risk assessment for the value in statin allocation in outpatients with suspected coronary artery disease (CAD).

Methods

For the 7860 eligible outpatients with suspected CAD who underwent CCTA, we evaluate hard atherosclerotic cardiovascular disease (ASCVD) and major adverse cardiac and cerebrovascular event (MACCE) stratified by guideline-recommended clinical risk assessment, and CCTA. For intermediate risk patients, we also compared the predictive value of CCTA and CAC.

Results

Over a median follow-up period of 3.6 years, a total of 83 (1.1 %) hard ASCVD and 170 (2.2 %) MACCE occurred. The event rate increased with both the intensity of statin recommendation (e.g., hard ASCVD: 1.5 per 1000 person-years [PY] for statin not recommended, 4.1 per 1000 PY for moderate-intensity statin, and 8.9 per 1000 PY for high-intensity statin) and the severity of coronary stenosis (e.g., hard ASCVD: 0.7 per 1000 PY for no plaque, 5.1 per 1000 PY for non-obstructive CAD, and 11.2 per 1000 PY for obstructive CAD). When stratified by CCTA, higher intensity statin recommendation was not a statistically significant independent risk factor, both for hard ASCVD and MACCE. For the predictive value of hard ASCVD in intermediate risk patients, there was no statistically significant difference between CCTA and CAC (the area under the receiver operating characteristic curve: 0.692 versus 0.702; P = 0.78).