| Abstract | Svrha rada: Analizirati prognostičku vrijednost CT-Leaman skora u poređenju s kalcijskim skorom po Agatstonu, SIS, SSS u kohorti pacijenata sa suspektnom KAB tijekom deset godina. Usporedit će se vrijeme doživljenja kod pacijenata s visokim i niskim CT-Leaman skorom ≥5,52, te onih s neopstruktivnom ili opstruktivnom koronarnom bolesti i visokim ili niskim CT Leaman skorom, te procijeniti utjecaj statina i aspirina.
----- Ispitanici i metode: Za populaciju pacijenata (N=261) iz kliničke baze podataka Specijalne bolnice Agram Zagreb upućenih 2008. godine na MSCT koronarografiju zbog sumnje na KAB, prikupljeni su demografski i klinički podaci, čimbenici kardiovaskularnog rizika, izračunati Diamond Forrester i Morise skor i kalcijski skor. Uzrok i datum smrti do 30. lipnja 2018. upareni su iz Registra umrlih HZJZ-a. Izračunati su CT Leaman, SIS i SSS, uspoređene Kaplan-Meierove krivulje doživljenja i načinjeni Cox-ovi regresijski modeli za ishode smrti bilo kojega uzroka i smrti kardiovaskularnog uzroka.
----- Rezultati: Kod 72% pacijenata dijagnosticirana je KAB, njih 57,4% imalo je neopstruktivnu koronarnu bolest, 47% visoko koronarno aterosklerotsko opterećenje, dok je 19,5% s neopstruktivnom bolesti imalo CT Leaman skor ≥5,52. Medijan CT Leaman skora za kohortu je 3,22, a za pacijente s KAB 5,22, prosječni SIS i SSS iznose 3,72 i 4,4. Tijekom praćenja utvrđeno je 26 smrti bilo kojeg uzroka od kojih je 10 kardiovaskularnog uzroka. CT Leaman skor ≥5,52 pokazao se kao značajan prediktor smrti bilo kojeg (p=0.003) i kardiovaskularnog uzroka (p=0.0019) u usporedbi s CT Leaman skorom<5,52. SIS, SSS i kalcijski skor su također značajni prediktori kardiovaskularne smrti (p=0.0147, p=0.017 i p=0,03) s omjerima hazarda CT-LeSc 38,0, SIS 8,2, SSS 7,9 i kalcijski skor 9,8. Uzimanje statina imalo je statistički značajan utjecaj (p=0,046) na duže doživljenje kod pacijenata s CT-LeSc ≥5,52 dok uzimanje aspirina nije (p=0,382).
----- Zaključak: Koronarno aterosklerotsko opterećenje procijenjeno temeljem CT specifičnih skorova ima značajnu prognostičku vrijednost za dugoročnu smrtnost bilo kojeg uzroka i kardiovaskularnog uzroka. |
| Abstract (english) | Objective: The objective of this study is to evaluate ten-year prognostic value of CT-LeSc in comparison with previously suggested CT scores, (SIS, SSS, CACS) in a cohort of patients with suspected coronary artery disease (CAD). To asses event-free survival in patients with high and low CT-LeSc previously defined by cut-off ≥5,52 as well as in patients with non-obstructive and obstructive CAD and high/low CT-LeSc. To compare SIS, SSS and CACS in different Cox models with CT-LeSc and assess the implication of baseline statin and aspirin therapy on survival.
----- Methods: Cohort of 261 patients from the clinical database of Special Hospital Agram Zagreb referred to coronary computed tomography angiography (CCTA) in 2008 from January the 1st. to June 30th. Demographic and clinical data, CAD pre-test probabilities by the Diamond-Forrester model and Morise score were obtained. Causes and dates of death were crosschecked from the registry of Croatian Institute of Public Health ending with 30th. June 2018. For each patient CACS, CT-LeSc, SIS and SSS were calculated. Kaplan-Meier survival curves and proportional Cox regression models for outcomes of all-cause death and cardiovascular death were compared.
----- Results: CAD was diagnosed in 72% of patients; 57.4% had non-obstructive CAD. The median CT-LeSc in the cohort was 3.22 and in patients with CAD 5.22. Among patients with CAD 47% had a high coronary atherosclerotic burden and 19.5% with non-obstructive CAD had a high CT-LeSc≥5.52. The mean SIS and SSS values were 3.72 and 4.4. The mean follow-up was 120.6±16.1 months, 26 deaths by all-cause (10 cardiovascular deaths) were recorded. High CT-Leaman score was independent predictor of all-cause (p=0.003) and CV death (p=0.0019) compared with CT-LeSc<5,52. SIS≥5, SSS ≥ 5 and CACS >400 were also independent predictors for CV death, (p=0.0147, p=0.017, p=0,03), respectively with hazard ratios CT-LeSc 38.0, SIS 8.2, SSS 7.9 and CACS 9,8. In patients with CT-LeSc ≥5,52 event-free survival was significantly longer (p=0,046) with statin therapy than without, however the difference for aspirin therapy was not significant (p=0,382).
----- Conclusion: Coronary atherosclerotic burden assessed by specific CT based scores has significant prognostic value for long-term cardiovascular and all-cause mortality. |
