通过640行冠状动脉计算机断层扫描血管造影评估冠状动脉狭窄的年龄相关分布和严重程度：一项横断面研究

摘要(中文译文)

冠状动脉计算机断层扫描血管造影（CCTA）是评估疑似冠状动脉疾病（CAD）的成熟无创影像学方法。然而，关于接受现代640排CCTA检查患者的冠状动脉狭窄模式及显著病变范围的数据仍然有限。本单中心横断面研究连续纳入2021年5月至2022年5月期间接受640排CCTA检查的390例疑似CAD患者。按冠状动脉节段及主要血管受累情况评估狭窄严重程度。临床显著狭窄定义为左主干冠状动脉（LM）管腔狭窄≥50%，或左前降支、右冠状动脉或左回旋支狭窄≥70%。显著CAD的范围分为单支血管病变、双支血管病变或左主干/三支血管病变。研究人群平均年龄为58.4±10.4岁，男性209例（53.6%）。女性年龄大于男性（61.4±10.3岁 vs. 55.8±10.1岁，p<0.001）。115例患者（29.5%）检出心肌桥，且男性较女性更为常见（73/209（34.9%）vs. 42/181（23.2%），p=0.011）。在所有冠状动脉节段中，大多数病变被分类为无至中度狭窄，而重度狭窄和完全闭塞较少见。CCTA检出显著狭窄者120例（30.8%），无显著狭窄者270例（69.2%）。单支血管病变、双支血管病变及左主干或三支血管病变分别为46例（11.8%）、41例（10.5%）和33例（8.5%）。年龄大于60岁的患者在左主干动脉、左前降支动脉（LAD）、右冠状动脉（RCA）和左回旋支动脉（LCx）中显著狭窄的比例均显著更高（均p<0.001）。在显著CAD患者中，病变范围在高年龄组存在性别差异，而在低年龄组无差异。在因疑似CAD接受640排CCTA检查的患者中，显著冠状动脉狭窄较为常见，且与高龄密切相关。伴有显著CAD的老年男性更易出现广泛病变，而心肌桥在男性中更为常见。这些发现凸显了640排CCTA在常规临床实践中详细刻画冠状动脉狭窄模式的临床价值。

Abstract

Coronary computed tomography angiography (CCTA) is an established noninvasive imaging modality for evaluating suspected coronary artery disease (CAD). However, data describing the pattern of coronary stenosis and the extent of significant disease in patients undergoing modern 640-row CCTA remain limited. This single-center cross-sectional study included 390 consecutive patients with suspected CAD who underwent 640-row CCTA between May 2021 and May 2022. Stenosis severity was assessed according to the coronary segment and major vessel involvement. Clinically significant stenosis was defined as luminal narrowing of ≥50% in the left main coronary artery (LM) or ≥70% in the left anterior descending, right coronary, or left circumflex arteries. The extent of significant CAD was categorized as single-vessel disease, two-vessel disease, or left main/three-vessel disease. The mean age of the study population was 58.4±10.4 years, and 209 patients (53.6%) were men. Women were older than men (61.4±10.3 vs. 55.8±10.1 years, p<0.001). Myocardial bridging was identified in 115 patients (29.5%) and was more common in men than in women (73/209 (34.9%) vs. 42/181 (23.2%), p=0.011). Across all coronary segments, most lesions were classified as none-to-moderate stenosis, whereas severe stenosis and total occlusion were less frequent. CCTA-detected significant stenosis was observed in 120 patients (30.8%), while 270 patients (69.2%) had non-significant stenosis. Single-vessel disease, two-vessel disease, and left main or three-vessel disease were present in 46 (11.8%), 41 (10.5%), and 33 patients (8.5%), respectively. Patients older than 60 years had significantly higher proportions of significant stenosis in the left main artery, left anterior descending artery (LAD), right coronary artery (RCA), and left circumflex artery (LCx) (all p<0.001). Among patients with significant CAD, the extent of disease differed by sex in the older age group but not in the younger age group. In patients undergoing 640-row CCTA for suspected CAD, significant coronary stenosis was common and strongly associated with older age. Older men with significant CAD were more likely to have extensive disease, while myocardial bridging was more frequent and common in men. These findings highlight the clinical value of 640-row CCTA in the detailed characterization of coronary stenosis patterns in routine clinical practice.

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