冠状动脉钙化在预测血管造影冠状动脉疾病范围方面的独立及增量价值：与心脏危险因素及放射性核素灌注成像的比较

Independent and incremental value of coronary artery calcium for predicting the extent of angiographic coronary artery disease: comparison with cardiac risk factors and radionuclide perfusion imaging.

作者信息

Schmermund A, Denktas A E, Rumberger J A, Christian T F, Sheedy P F, Bailey K R, Schwartz R S

机构信息

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, USA.

出版信息

J Am Coll Cardiol. 1999 Sep;34(3):777-86. doi: 10.1016/s0735-1097(99)00265-x.

DOI:10.1016/s0735-1097(99)00265-x

PMID:10483960

Abstract

OBJECTIVES

The study was done to test the ability to predict the extent of angiographically determined coronary artery disease (CAD) by quantification of coronary calcium using electron-beam computed tomography (EBCT) and to compare it with more conventional parameters for delineating the angiographic extent of CAD, that is, cardiovascular risk factors and radionuclide single-photon emission computed tomography (SPECT).

BACKGROUND

The angiographic extent of CAD is a powerful predictor of subsequent events. Use of EBCT may be able to define it by virtue of its ability to determine plaque burden.

METHODS

We examined 308 patients presenting with suspected but not previously known CAD who underwent selective coronary angiography. As measures of the angiographic extent of CAD, coronary artery greater even 20 (CAGE > or =20) and CAGE > or =50 scores represented the total number of coronary segments with > or =20% or > or =50% stenoses, respectively. The EBCT-derived total calcium scores were obtained in 291 patients, risk factors as defined by the National Cholesterol Education Program in 239 patients, and SPECT scans in 136 patients.

RESULTS

Using multiple linear regression analysis, total calcium scores were better independent predictors of both CAGE > or =20 and CAGE > or =50 scores than either a SPECT-derived radionuclide perfusion score or the risk factors age, male gender and ratio of total/high-density lipoprotein (HDL) cholesterol. The association between EBCT and angiographic scores remained highly significant after excluding the influence of all interrelated risk factors and SPECT variables (r = 0.65; p < 0.001 for CAGE > or =20 scores, r = 0.50; p < 0.001 for CAGE > or =50 scores).

CONCLUSIONS

Coronary calcium predicts the angiographic extent of CAD in symptomatic patients and provides independent and incremental information to the more conventional clinical parameters derived from SPECT or risk assessment.

摘要

目的

本研究旨在通过电子束计算机断层扫描（EBCT）对冠状动脉钙化进行定量分析，以测试预测血管造影确定的冠状动脉疾病（CAD）范围的能力，并将其与用于描绘CAD血管造影范围的更传统参数（即心血管危险因素和放射性核素单光子发射计算机断层扫描（SPECT））进行比较。

背景

CAD的血管造影范围是后续事件的有力预测指标。EBCT的使用可能因其确定斑块负荷的能力而能够对其进行定义。

方法

我们检查了308例疑似但先前未确诊CAD且接受选择性冠状动脉造影的患者。作为CAD血管造影范围的测量指标，冠状动脉大于等于20（CAGE≥20）和CAGE≥50评分分别代表狭窄≥20%或≥50%的冠状动脉节段总数。在291例患者中获得了EBCT衍生的总钙评分，在239例患者中获得了由国家胆固醇教育计划定义的危险因素，在136例患者中进行了SPECT扫描。

结果

使用多元线性回归分析，总钙评分比SPECT衍生的放射性核素灌注评分或危险因素年龄、男性性别以及总胆固醇/高密度脂蛋白（HDL）胆固醇比值更好地独立预测CAGE≥20和CAGE≥50评分。在排除所有相互关联的危险因素和SPECT变量的影响后，EBCT与血管造影评分之间的关联仍然高度显著（对于CAGE≥20评分，r = 0.65；p < 0.001；对于CAGE≥50评分，r = 0.50；p < 0.001）。