Abstract：
Objective: To investigate the value of myocardium scar area in predicting adverse cardiovascular events (MACEs) after coronary artery bypass grafting (CABG) in patients with ischemic cardiomyopathy (ICM). Methods: The first part of this study was a retrospective study. Patients diagnosed with ICM and undergoing CABG surgery at Beijing Anzhen Hospital, Capital Medical University from January 2017 to December 2022 were enrolled as the discovery cohort. All patients underwent cardiac magnetic resonance-late gadolinium enhancement (CMR-LGE) before surgery. According to the occurrence of postoperative MACEs, the patients were divided into MACEs group and MACEs-free group. Preoperative clinical and imaging data, intraoperative and postoperative data were collected and compared between the two groups. The primary endpoint was postoperative MACEs. Univariate and multifactor regression analyses were used to analyze the risk factors for MACEs. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive efficacy and optimal cut-off value of myocardial scar area for endpoint events. The second part of this study was a prospective study. Patients with ICM who received CABG at Beijing Anzhen Hospital, Capital Medical University from January 2023 to June 2023 were enrolled as a validation cohort, and were divided into MACEs group and MACEs-free group according to whether MACEs occurred after surgery. Preoperative clinical and imaging data, intraoperative and postoperative data were collected and compared between the two groups. Verify the reliability of the cut-off value obtained by ROC curve in the validation cohort. Results: A total of 120 patients with ICM (30 patients in MACEs group and 90 patients in MACEs-free group), aged (61.6±8.7) years, including 93 males, were included in the discovery cohort. A total of 22 ICM patients (5 patients in MACEs group and 17 patients in MACEs-free group), aged (59.5±8.2) years, including 18 males, were included in the validation cohort. Multivariate Cox regression showed that myocardial scar area (HR=1.258, 95%CI 1.096-1.444, P=0.001) was an independent risk factor for the primary endpoint event. The area under ROC curve of myocardial scar area for predicting postoperative MACEs was 0.90 (95%CI 0.83-0.95), and myocardial scar area≥36.0% was the optimal cut-off value for predicting postoperative MACEs, and its sensitivity, specificity and accuracy were 96.7%, 72.2% and 78.3%, respectively. In the validation cohort, the sensitivity, specificity and accuracy of myocardial scar area in predicting postoperative MACEs in patients with ICM after CABG were 80.0%, 82.4% and 81.8%, respectively. Conclusion: Myocardial scar area is an independent risk factor for MACEs after CABG in patients with ICM, and myocardial scar area≥36.0% is the optimal cut-off value for predicting MACEs after CABG. Myocardial scar area can help to identify patients at high risk of surgery and provide a basis for risk stratification of patients.
目的： 探讨心肌瘢痕面积预测缺血性心肌病患者冠状动脉旁路移植（CABG）术后发生不良心血管事件（MACEs）的价值。 方法： 本研究第1部分为回顾性研究，入选2017年1月至2022年12月在首都医科大学附属北京安贞医院诊断为缺血性心肌病并接受CABG手术治疗的患者作为发现队列，入选患者术前均行心脏磁共振-延迟钆强化检查，根据术后是否发生MACEs分为MACEs组和无MACEs组。收集并比较两组患者术前临床及影像资料、术中及术后相关资料。主要终点为术后发生MACEs。采用单因素和多因素回归分析影响缺血性心肌病患者CABG术后发生MACEs的相关危险因素，构建受试者工作特征（ROC）曲线，评估心肌瘢痕面积对终点事件的预测效能和最佳临界值。本研究第2部分为前瞻性研究，入选2023年1至6月在首都医科大学附属北京安贞医院接受CABG的缺血性心肌病患者作为验证队列，根据术后是否发生MACEs分为MACEs组和无MACEs组，收集并比较两组患者术前临床及影像资料、术中及术后相关资料。在验证队列中验证ROC曲线获得界值的可靠性。 结果： 发现队列共纳入120例缺血性心肌病患者（MACEs组30例，无MACEs组90例），年龄（61.6±8.7）岁，男性93例。验证队列共纳入22例缺血性心肌病患者（MACEs组5例，无MACEs组17例），年龄（59.5±8.2）岁，男性18例。多因素Cox回归示心肌瘢痕面积（HR=1.258，95%CI：1.096~1.444，P=0.001）是主要终点事件的独立危险因素。心肌瘢痕面积预测术后发生MACEs的ROC曲线下面积为0.90（95%CI：0.83~0.95），心肌瘢痕面积≥36.0%是预测术后发生MACEs的最佳临界值，其敏感度、特异度和准确度分别为96.7%、72.2%和78.3%。在验证队列中，心肌瘢痕面积预测缺血性心肌病患者CABG术后发生MACEs的敏感度、特异度和准确度分别为 80.0%，82.4%和81.8%。 结论： 心肌瘢痕面积是缺血性心肌病患者CABG术后是否发生MACEs的独立危险因素，心肌瘢痕面积≥36.0%是预测CABG术后是否发生MACEs的最佳临界值。该指标有助于识别手术高危患者，为患者危险分层提供依据。.
目的： 探讨心肌瘢痕面积预测缺血性心肌病患者冠状动脉旁路移植（CABG）术后发生不良心血管事件（MACEs）的价值。 方法： 本研究第1部分为回顾性研究，入选2017年1月至2022年12月在首都医科大学附属北京安贞医院诊断为缺血性心肌病并接受CABG手术治疗的患者作为发现队列，入选患者术前均行心脏磁共振-延迟钆强化检查，根据术后是否发生MACEs分为MACEs组和无MACEs组。收集并比较两组患者术前临床及影像资料、术中及术后相关资料。主要终点为术后发生MACEs。采用单因素和多因素回归分析影响缺血性心肌病患者CABG术后发生MACEs的相关危险因素，构建受试者工作特征（ROC）曲线，评估心肌瘢痕面积对终点事件的预测效能和最佳临界值。本研究第2部分为前瞻性研究，入选2023年1至6月在首都医科大学附属北京安贞医院接受CABG的缺血性心肌病患者作为验证队列，根据术后是否发生MACEs分为MACEs组和无MACEs组，收集并比较两组患者术前临床及影像资料、术中及术后相关资料。在验证队列中验证ROC曲线获得界值的可靠性。 结果： 发现队列共纳入120例缺血性心肌病患者（MACEs组30例，无MACEs组90例），年龄（61.6±8.7）岁，男性93例。验证队列共纳入22例缺血性心肌病患者（MACEs组5例，无MACEs组17例），年龄（59.5±8.2）岁，男性18例。多因素Cox回归示心肌瘢痕面积（HR=1.258，95%CI：1.096~1.444，P=0.001）是主要终点事件的独立危险因素。心肌瘢痕面积预测术后发生MACEs的ROC曲线下面积为0.90（95%CI：0.83~0.95），心肌瘢痕面积≥36.0%是预测术后发生MACEs的最佳临界值，其敏感度、特异度和准确度分别为96.7%、72.2%和78.3%。在验证队列中，心肌瘢痕面积预测缺血性心肌病患者CABG术后发生MACEs的敏感度、特异度和准确度分别为 80.0%，82.4%和81.8%。 结论： 心肌瘢痕面积是缺血性心肌病患者CABG术后是否发生MACEs的独立危险因素，心肌瘢痕面积≥36.0%是预测CABG术后是否发生MACEs的最佳临界值。该指标有助于识别手术高危患者，为患者危险分层提供依据。.
摘要：
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