Application Of Calcification Scores In Decision Making Of Revascularization Therapy For Complex Coronary Heart Disease

Background Three-vessel and left main coronary artery disease(3VD/LM)are associated with more comorbidities and worse outcomes.Coronary revascularization procedures(coronary artery bypass grafting or percutaneous coronary intervention)are standard treatment strategies.At present,there are no widely accepted tools for assessing the appropriateness of coronary revascularization in China.Objective To investigate the difference of coronary calcium score in patients with complex coronary heart disease(including three-vessel and left main coronary artery disease)who received different coronary revascularization therapies,and to study its clinical value in the decision-making of revascularization therapies of 3VD/LM.Methods This retrospective clinical study was conducted to screen the patients who were diagnosed with coronary heart disease in Dongfeng General Hospital from October 2017 to November 2018.98 patients with 3VD/LM were involved in this study according to the results of coronary angiography,all of them have receiced CABG(coronary artery bypass grafting)or PCI(percutaneous coronary intervention).Based on the different therapies of coronary revascularization(CRV),these patients were divided into CABG group or PCI group.Both groups have received coronary calcium score(CACS)scan before operation,and the calcium scores of each coronary artery branch,the total calcium scores,the calcium scores of severe stenosis segment were calculated,and the difference of calcium scores between the two groups was analyzed by using the SPSS 22.0.Results The scores of anterior descending artery(LAD),left circumflex artery(LCX),right coronary artery(RCA),total calcification score and the calcification scores of severe stenosis segment in CABG group were significantly higher than those in PCI group(P< 0.01).There was no obvious difference in calcium score of left main artery(LM)between the two groups.Comparing with the degree of coronary calcification between two groups,moderate calcification was predominant in PCI group while severe calcification was predominant in CABG group(P < 0.05).The average number of severe stenosis segments and the average CACS of severe stenosis segments in CABG group were significantly higher than those in PCI group(P < 0.01).The optimum boundaries of LAD,LCX,RCA calcium score and total calcium score are 149.5,143.0,128.5 and493.5 respectively according to the ROC curve.Conclusion 1.There was significant difference in CACS between two groups of patients with 3VD/LM who have received PCI or CABG: CACS(LAD,LCX,R CA)and total CACS in CABG group were obviously higher than those in PCI group,and the CACS of severe stenosis segment in CABG group was also much higher than those in PCI group.2.Preoperative measurement of CACS is valuable for clinical decision-making on the revascularization therapies for patients with 3VD/LM.According to ROC curve,it can provide accurate CACS reports and subsidiary recommendation for the clinic.It is also conducive to the formulation of operation schemes,equipment preparation,risk and efficacy evaluation before PCI.