2023 年第 7 期 第 18 卷

冠状动脉周围脂肪衰减指数与不稳定型心绞痛患者经皮冠状动脉介入治疗后不良心血管事件的相关性研究

Correlation between pericoronary fat attenuation index and adverse cardiovascular events in patients with unstable angina pectoris undergoing percutaneous coronary intervention

作者：张海丹1李凤娟2徐磊3王媛2杜杰2

英文作者：Zhang Haidan1 Li Fengjuan2 Xu Lei3 Wang Yuan2 Du Jie2

单位：1北京市心肺血管疾病研究所心血管生物研究室，北京100029；2北京市心肺血管疾病研究所心血管生物研究室首都医科大学附属北京安贞医院教育部重塑相关心血管疾病重点实验室心血管重大疾病防治协同中心，北京100029；3首都医科大学附属北京安贞医院医学影像科，北京100029

英文单位：1Cardiovascular Biology Laboratory Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China; 2Cardiovascular Biology Laboratory Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing Anzhen Hospital Capital Medical University Key Laboratory of Remodeling-related Cardiovascular Disease Ministry of Education & Collaborative Innovation Center for Cardiovascular Disorder Beijing 100029 China; 3Department of Medical Imaging Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：不稳定型心绞痛；不良心血管事件；冠状动脉周围脂肪衰减指数；全球急性冠状动脉事件注册评分

英文关键词：Unstableanginapectoris;Adversecardiovascularevents;Pericoronaryfatattenuationindex;Globalregistryofacutecoronaryeventsscore

• 摘要：

• 目的  探究冠状动脉周围脂肪衰减指数(FAI)与不稳定型心绞痛(UA)患者经皮冠状动脉介入(PCI)治疗后不良心血管事件的相关性。方法  回顾性分析2019年1—4月于首都医科大学附属北京安贞医院住院行PCI治疗的442例UA患者的临床资料及影像资料。随访观察不良心血管事件发生情况。根据有无不良心血管事件发生将患者分为事件组和非事件组。分析患者冠状动脉周围FAI，对患者进行全球急性冠状动脉事件注册(GRACE)评分。比较2组患者临床资料，利用受试者工作特征（ROC）曲线分析FAI、GRACE评分单独及联合预测不良心血管事件的效能。采用Cox回归方法分析FAI与不良心血管事件的相关性，采用Kaplan-Meier生存曲线评价2组患者不良心血管事件发生率。结果  所有患者随访3.6（3.5,3.7）年，其中40例（9.0%）发生不良心血管事件（事件组），非事件组402例。事件组患者FAI、GRACE评分均高于非事件组（均P＜0.05）。ROC曲线分析结果显示，FAI、GRACE评分单独及联合预测UA患者PCI术后发生不良心血管事件的曲线下面积分别为0.689、0.704、0.767，GRACE评分联合FAI预测的曲线下面积高于GRACE评分单独预测（P＜0.05）。Cox回归分析结果表明，校正性别、年龄及临床危险因素后，FAI仍是UA患者PCI术后不良心血管事件发生的独立危险因素（风险比=2.25，P=0.001）。Kaplan-Meier生存曲线分析结果显示，FAI≥-72.83 HU的UA患者PCI术后不良心血管事件发生率高于FAI＜-72.83 HU的患者（Log-rank P＜0.001）。结论  FAI是UA患者PCI术后发生不良心血管事件的预测因子，FAI联合GRACE评分可以提高对不良心血管事件的预测效能。

• Objective  To investigate the correlation between pericoronary fat attenuation index (FAI) and adverse cardiovascular events in patients with unstable angina pectoris (UA) after percutaneous coronary intervention (PCI). Methods  The clinical and imaging data of 442 patients with UA admitted to Beijing Anzhen Hospital, Capital Medical University for PCI treatment from January to April 2019 were retrospectively analyzed. The occurrence of adverse cardiovascular events were followed up and observed. Patients were divided into event group and non-event group based on the occurrence of adverse cardiovascular events. Patient′s FAI was analyzed and global registry of acute coronary events risk(GRACE) score was performed. The clinical data of the two groups were compared, and the receiver operating characteristic (ROC) curve was used to analyze the efficacy of FAI and GRACE score alone and in combination in predicting adverse cardiovascular events. Cox regression method was used to analyze the correlation between FAI and adverse cardiovascular events, and Kaplan-Meier survival curve was used to evaluate the incidence of adverse cardiovascular events in the two groups. Results  All patients were followed up for 3.6(3.5,3.7)years, of which 40(9.0%) patients had adverse cardiovascular events (event group) and 402 patients had no adverse cardiovascular events (non-event group). The FAI and GRACE scores of patients in the event group were higher than those in the non-event group (both P＜0.05). The ROC curve analysis results showed that the area under the curve predicted by FAI and GRACE scores alone and in combination for adverse cardiovascular events in UA patients after PCI were 0.689, 0.704, and 0.767, respectively. The area under the curve predicted by GRACE scores combined with FAI was higher than that predicted by GRACE scores alone (P＜0.05). Cox regression analysis showed that after adjusting for gender, age, and clinical risk factors, FAI was still an independent risk factor for adverse cardiovascular events in UA patients after PCI (hazard ratio=2.25, P=0.001). Kaplan-Meier survival curve analysis showed that the incidence of adverse cardiovascular events in UA patients with FAI≥-72.83 HU after PCI was higher than that in patients with FAI＜-72.83 HU(Log-rank P＜0.001). Conclusions    FAI is a predictor of adverse cardiovascular events in patients with UA after PCI. FAI combined with GRACE score can improve the predictive efficacy of adverse cardiovascular events.