Raggi P, Callister T Q, Cooil B, He Z X, Lippolis N J, Russo D J, Zelinger A, Mahmarian J J
EBT Research Foundation and Vanderbilt University, Nashville, TN 37075, USA.
Circulation. 2000 Feb 29;101(8):850-5. doi: 10.1161/01.cir.101.8.850.
There is a clear relationship between absolute calcium scores (CS) and severity of coronary artery disease. However, hard coronary events have been shown to occur across all ranges of CS.
We conducted 2 analyses: in group A, 172 patients underwent electron-beam CT (EBCT) imaging within 60 days of suffering an unheralded myocardial infarction. In group B, 632 patients screened by EBCT were followed up for a mean of 32+/-7 months for the development of acute myocardial infarction or cardiac death. The mean patient age and prevalence of coronary calcification were similar in the 2 groups (53+/-8 versus 52+/-9 years and 96% each). In group B, the annualized event rate was 0.11% for subjects with CS of 0, 2.1% for CS 1 to 99, 4.1% for CS 100 to 400, and 4.8% for CS >400, and only 7% of the patients had CS >400. However, mild, moderate, and extensive absolute CSs were distributed similarly between patients with events in both groups (34%, 35%, and 27%, respectively, in group A and 44%, 30%, and 22% in group B). In contrast, the majority of events in both groups occurred in patients with CS >75th percentile (70% in each group).
Coronary calcium is present in most patients who suffer acute coronary events. Although the event rate is greater for patients with high absolute CSs, few patients have this degree of calcification on a screening EBCT. Conversely, the majority of events occur in individuals with high CS percentiles. Hence, CS percentiles constitute a more effective screening method to stratify individuals at risk.
绝对钙评分（CS）与冠状动脉疾病的严重程度之间存在明确的关系。然而，已证明在所有CS范围内都会发生严重的冠状动脉事件。
我们进行了两项分析：在A组中，172例患者在发生未预告的心肌梗死后60天内接受了电子束CT（EBCT）成像。在B组中，对632例经EBCT筛查的患者进行了平均32±7个月的随访，以观察急性心肌梗死或心源性死亡的发生情况。两组患者的平均年龄和冠状动脉钙化患病率相似（分别为53±8岁和52±9岁，均为96%）。在B组中，CS为0的受试者年化事件发生率为0.11%，CS为1至99的为2.1%，CS为100至400的为4.1%，CS>400的为4.8%，只有7%的患者CS>400。然而，两组发生事件的患者中，轻度、中度和广泛的绝对CS分布相似（A组分别为34%、35%和27%；B组分别为44%、30%和22%）。相比之下，两组中的大多数事件发生在CS>第75百分位数的患者中（每组均为70%）。
大多数发生急性冠状动脉事件的患者存在冠状动脉钙化。虽然绝对CS高的患者事件发生率更高，但在EBCT筛查中很少有患者有这种程度的钙化。相反，大多数事件发生在CS百分位数高的个体中。因此，CS百分位数构成了一种更有效的筛查方法，用于对高危个体进行分层。
