| Objective:By studying the clinical data,laboratory tests,imaging data and other indicators of patients diagnosed with diffuse coronary artery dilatation in the First Hospital of Jida,and analyzing the occurrence of adverse cardiovascular events and other prognostic indicators during follow-up,the clinical characteristics and risk factors of diffuse coronary artery dilatation and the predictive value of CTFC for the prognosis of CAE were found.The risk stratification of CAE patients should be carried out in time,and the appropriate and individualized treatment plan should be selected.Methods:A total of 129 patients with diffuse coronary artery dilatation diagnosed by coronary angiography in the Catheterization Laboratory of the First Hospital of Kedah from December 2019 to August 2022 were enrolled,and 129 patients with coronary atherosclerotic heart disease without coronary artery dilatation were randomly selected according to the gender ratio.Their clinical data were collected.SPSS 26.0software was used to analyze and process the data.Univariate analysis and binary logistic regression analysis were used to determine the risk factors of diffuse coronary artery dilatation.Image data were analyzed by analysis of variance to determine the differences between different dilated coronary arteries,linear regression was used to analyze the influencing factors of CTFC in dilated coronary arteries,and Kaplan-Meier method was used to analyze the survival of patients,and multivariate COX regression model was used to analyze the prognostic factors.Finally,ROC curve was used to determine the predictive value of each imaging index for recurrent angina pectoris in patients with coronary artery dilation.Results:There is a total of 258 patients enlisted in this study,of which 129 patients with diffuse coronary artery dilatation,and the control group included 129 patients with coronary atherosclerotic heart disease without aneurysmal dilatation.(1)Baseline characteristics: hypertension,diabetes and LDL-C are associated with the risk of CAE(OR=2.89,95%CI: 1.59-5.26,P=0.001;OR=2.01,95%CI:1.00-4.02,P=0.048;OR=1.61,95%CI: 1.11-2.34,P=0.011).A higher proportion of three-vessel disease and more severe coronary stenosis was detected in patients in CAE group than that in control group(OR=3.06,95%CI:1.65-5.68,P<0.001).The level of fibrinogen was higher in CAE patients(OR=1.40,95%CI:1.01-1.95,P=0.045).(2)Imaging data characteristics: the expanded area and length of dilated segment of RCA were significantly higher than those of LAD and LCX(P=0.037,P=0.003;P=0.004,P<0.001),and the CTFC value was slightly higher than that of LCX,and both are significantly higher than that of LAD(P=0.011,P=0.044).With CTFC as the dependent variable,the maximum diameter,linear dimension and expanded area wererespectively included in the linear regression equation,and their effects on CTFC were statistically significant(P<0.001).(3)Prognostic features: A total of 109 CAE patients were followed up in this study,19 patients were lost to follow-up,3 patients were excluded for planned CABG treatment,and 106 patients were analyzed for prognosis and endpoint events.The median follow-up time was 25 months,53 patients(49%)had more than three times of angina symptoms after discharge,26 patients(23%)were readmitted due to cardiac reasons.MACE events occurred in 20 patients(19%),including 3 patients with cardiac death(2%),9 patients with recurrent myocardial infarction(8%),and 14 patients with unplanned revascularization(13%).The survival time of CAE patients with ST-segment elevation myocardial infarction at admission was significantly lower than that of CAE patients with unstable angina pectoris(UAP),non-ST-segment elevation myocardial infarction and non-coronary heart disease(Breslow P=0.032).The survival time of patients with three-vessel disease was significantly lower than that of patients without it(Breslow P=0.021).Multivariate COX regression analysis showed that ST-segment elevation myocardial infarction had a statistically significant impact on survival time compared with other diagnosis(HR:3.497,95%CI:1.25-9.75,P=0.017).The impact of three-vessel disease on survival time was statistically significant compared with other diseases(HR: 2.908,95%CI:1.04-8.13,P=0.042).Binary Logistic regression analysis showed that the increase of CTFC increased the risk of recurrent angina pectoris(OR=1.046,95%CI:1.007-1.087,P<0.05).Revascularization(dilated OR other vessels)reduced the risk of recurrent angina(OR=0.175,95%CI:0.063-0.491,P=0.001).ROC curve analysis showed that CTFC had the best predictive effect on recurrent angina in CAE patients,with a cut-off value of 30.5f,a sensitivity of 0.79,a specificity of 0.44,and an area under the curve of0.70(95%CI:0.602-0.802;P<0.001).Conclusions:(1)Hypertension,diabetes and LDL-C are independent risk factors for diffuse coronary artery dilatation.Patients with diffuse coronary artery dilatation have higher fibrinogen levels and a higher risk of thrombosis.(2)Patients with diffuse coronary dilatation often have concurrent coronary atherosclerotic heart disease and a higher proportion of three-vessel disease.(3)Diffuse coronary dilatation was most common in RCA,followed by LCX,and finally LAD.The corrected TIMI frame number of dilated vessels was related to the maximum diameter,length and area of dilated segments.(4)Patients with diffuse coronary dilatation combined with three-vessel disease and clinically diagnosed as St-segment elevation myocardial infarction have a greater risk of cardiovascular adverse events.(5)There is a significant association between Higher corrected TIMI frame count and higher risk of recurrent angina pectoris in patients with diffuse coronary dilatation.In patients with diffuse coronary dilatation corrected TIMI frame count can effectively predict the risk of recurrent angina pectoris.For patients with diffuse coronary dilatation and coronary artery disease,timely revascularization of stenotic vessels is beneficial to reduce the risk of recurrent angina pectoris. |
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