【Coronary CT Angiography and 5-Year Risk of Myocardial Infarction 冠狀動脈CT血管造影和5年心肌梗死風險】
Angiography n.血管造影
Randomly adv.隨機地
Revascularization n.血運重建
Although coronary computed tomographic angiography (CTA) improves diagnostic certainty in the assessment of patients with stable chest pain, its effect on 5-year clinical outcomes is unknown. In this study, 4146 patients with stable chest pain who had been referred to a cardiology clinic for evaluation were randomly assigned to standard care plus CTA or to standard care alone. The 5-year rate of death from coronary heart disease or nonfatal myocardial infarction was lower in the CTA group than in the standard-care group (2.3% vs. 3.9%). Although the rates of invasive coronary angiography and coronary revascularization were higher in the CTA group than in the standard-care group in the first few months of follow-up, overall rates were similar at 5 years. However, more preventive therapies were initiated in patients in the CTA group, as were more antianginal therapies. There were no significant between group differences in the rates of cardiovascular or noncardiovascular deaths or deaths from any cause. In this trial, the use of CTA in addition to standard care in patients with stable chest pain resulted in a significantly lower rate of death from coronary heart disease or nonfatal myocardial infarction at 5 years than standard care alone, without resulting in a significantly higher rate of coronary angiography or coronary revascularization.1
【譯文】儘管冠狀動脈計算機斷層掃描血管造影（CTA）提高了對穩定性胸痛患者評估的診斷確定性，但其對5年臨床結果的影響尚不清楚。這項研究中，4146名有穩定性胸痛的患者被送至心臟病診所進行評估，他們被隨機分配到標準治療加CTA組或單獨的標準治療組。CTA組冠心病或非致死性心肌梗塞的5年死亡率低於標準治療組（2.3％對3.9％）。雖然在隨訪的前幾個月中，CTA組的侵入性冠狀動脈造影和冠狀動脈血運重建率高於標準治療組，但5年時總體發生率相似。然而，CTA組患者開始接受更多的預防性治療，更多的抗心絞痛治療也是如此。在任何由心血管或者非心血管導致的死亡率上，沒有顯著的組間差異。在這項試驗中，除穩定性胸痛患者的標準治療外，使用CTA導致5年內冠心病或非致死性心肌梗死的死亡率顯著低於單獨的標準治療，而沒有導致顯著的更高比率的冠狀動脈造影或冠狀動脈血運重建術。
【醫學單詞記憶之道】
1. 常用醫學詞組
coronary computed tomographic angiography 冠狀動脈CT造影
coronary heart disease 冠狀動脈心臟病
myocardial infarction 心肌梗塞
coronary angiography 冠狀動脈造影
coronary revascularization
冠狀動脈血運重建術
【醫學英語延伸閱讀】
Coronary computed tomography angiography (CCTA) uses an injection of iodine-containing contrast material and CT scanning to examine the arteries that supply blood to the heart and determine whether they have been narrowed. The images generated during a CT scan can be reformatted to create three-dimensional(3D) images that may be viewed on a monitor, printed on film or by a 3D printer, or transferred to electronic media.2
The data from the SCOT-HEART trial suggest that management that is informed by results of CTA is associated with a lower rate of myocardial infarction than management that is informed by results of stress ECG testing. There may even be the potential for a lower incidence of myocardial infarction when CTA data are used than when data from any functional test are used. Ananalysis from PROMISE shows that a substantial proportion of myocardial infarctions occurred in patients with nonobstructive coronary artery disease identified by CTA- disease that would not be detected by functional testing. It would be reasonable to consider aggressive secondary prevention in these patients, although this specific approach has not been evaluated in a clinical trial. The editorials also believe that leveraging data from trials such as SCOT-HEART and PROMISE may allow more efficient targeting of noninvasivetesting while continuing to drive improvement in vascular outcomes. The more general message from these trials is that the information provided by a diagnostic test can resonate therapeutically beyond making a correct diagnosis of coronary artery disease and that clinicians should aggressively pursue preventive measures to achieve the best outcomes possible while minimizing daily symptoms.3
參考文獻
1. The SCOT-HEART Investigators*. Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. N Engl J Med 2018; 379:924-933.
2. RadiologyInfo.org 網站
3. Udo Hoffmann and James E. Udelson. Imaging Coronary Anatomy and Reducing MyocardialInfarction. N Engl J Med 2018; 379:977-978.
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