在实际临床实践中诊断阻塞性冠状动脉疾病的当代算法

A. Sumin, A. V. Starovoytova, A. V. Shcheglova, E. V. Gorbunova
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Based on the results of coronary angiography, the following groups were identified: group I – obstructive lesion of the coronary arteries (≥ 70 %) (n = 50); group II – non-obstructive lesion of the coronary arteries (< 70 %) (n = 32); group III – intact coronary arteries (n = 40). Results. According to the results of coronary angiography, the frequency of detection of obstructive lesion of the coronary arteries was 42 % (in patients without past medical history of myocardial infarction – 31 %). Before performing coronary angiography, non-invasive tests were performed in 2.5 % of cases. Pain in the chest was represented by typical angina in 74 % of patients, with no difference in frequency in all groups. PTP values were statistically significantly higher in the group with obstructive CHD (median – 32 %), however, in the other two groups, PTP values corresponded to a high risk of obstructive CHD (median – 27 % and 21 %, respectively). 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摘要

背景。尽管目前国际上关于稳定型冠心病(CHD)和慢性冠脉综合征的建议具有较高的证据水平,但在国内临床实践中的执行力度却不够。分析实际临床实践中疑似阻塞性冠心病患者对诊断手段(无创和有创)的选择。该研究纳入了疑似阻塞性冠心病的门诊患者,对其阻塞性冠心病的预检概率(PTP)进行了测定;如果 PTP = 5-15%,则根据冠心病危险因素对临床概率进行评估。根据冠状动脉造影结果,确定以下组别:I 组--冠状动脉阻塞性病变(≥ 70%)(n = 50);II 组--冠状动脉非阻塞性病变(< 70%)(n = 32);III 组--冠状动脉完好(n = 40)。结果冠状动脉造影结果显示,冠状动脉阻塞性病变的检出率为 42%(既往无心肌梗死病史的患者为 31%)。在进行冠状动脉造影术之前,2.5%的病例进行了无创检查。74%的患者胸部疼痛表现为典型的心绞痛,各组患者的疼痛频率没有差异。据统计,阻塞性冠状动脉疾病组的 PTP 值明显更高(中位数为 32%),但在其他两组中,PTP 值与阻塞性冠状动脉疾病的高风险相对应(中位数分别为 27% 和 21%)。PTP是阻塞性冠心病和后续心肌血运重建的独立预测因子。在有创冠状动脉造影检查的疑似冠心病门诊患者中,冠状动脉阻塞性病变的发生率仍然很低。在个别病例中进行了无创检查,而 PTP 是阻塞性冠心病和随后心肌血管重建的独立预测因子。为了提高阻塞性冠心病的检出率,我们应遵守欧洲心脏病学会的诊断算法,并更广泛地使用无创成像检查。
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Contemporary algorithms for diagnosing obstructive coronary artery disease in real clinical practice
Background. Despite the high evidence level of the currently existing international recommendations on stable coronary heart disease (CHD) and chronic coronary syndrome, their implementation in domestic clinical practice is insufficient.The aim of the work. To analyze the choice of diagnostic tactics (non-invasive and invasive) in patients with suspected obstructive coronary heart disease in real clinical practice.Methods. The study included outpatients with suspected obstructive CHD, in whom the pre-test probability (PTP) of obstructive CHD was determined; if PTP = 5–15 %, clinical probability was assessed based on CHD risk factors. Based on the results of coronary angiography, the following groups were identified: group I – obstructive lesion of the coronary arteries (≥ 70 %) (n = 50); group II – non-obstructive lesion of the coronary arteries (< 70 %) (n = 32); group III – intact coronary arteries (n = 40). Results. According to the results of coronary angiography, the frequency of detection of obstructive lesion of the coronary arteries was 42 % (in patients without past medical history of myocardial infarction – 31 %). Before performing coronary angiography, non-invasive tests were performed in 2.5 % of cases. Pain in the chest was represented by typical angina in 74 % of patients, with no difference in frequency in all groups. PTP values were statistically significantly higher in the group with obstructive CHD (median – 32 %), however, in the other two groups, PTP values corresponded to a high risk of obstructive CHD (median – 27 % and 21 %, respectively). PTP was an independent predictor for obstructive CHD and subsequent myocardial revascularization.Conclusion. In the cohort of outpatients with suspected coronary heart disease we examined during invasive coronary angiography, the frequency of obstructive lesion of the coronary arteries remains low. Non-invasive tests were performed in isolated cases, while PTP was an independent predictor for obstructive CHD and subsequent myocardial revascularization. To increase the frequency of detection of obstructive coronary heart disease, we should adhere to the diagnostic algorithms of the European Society of Cardiology and make wider use of non-invasive imaging tests.
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