O'Malley P G, Taylor A J, Jackson J L, Doherty T M, Detrano R C
General Internal Medicine Service, Walter Reed Army Medical Center, Washington, DC, USA.
Am J Cardiol. 2000 Apr 15;85(8):945-8. doi: 10.1016/s0002-9149(99)00906-6.
The predictive ability of electron-beam computed tomography (EBCT) for coronary heart disease outcomes, particularly hard coronary outcomes (myocardial infarction or death), has been questioned in asymptomatic populations. Our objective was to synthesize data on the use of EBCT for determining cardiovascular prognosis in asymptomatic populations. Studies were identified using standard systematic review methods. The outcome of interest was relative risk for myocardial infarction or sudden death, and combined events including revascularization. Nine articles met the inclusion criteria, of which 5 were of independent studies. Using meta-analytic techniques to synthesize prognostic data, there was an increased risk (summary risk ratio 8.7, 95% confidence interval 2.7 to 28.1) of a combined outcome of nonfatal myocardial infarction or death or revascularization if the calcium score was above a median score. Similarly, there was an increased risk for hard events: myocardial infarction or death (summary risk ratio 4.2, 95% confidence interval 1.6 to 11.3). However, there was significant heterogeneity in the studies' quality and patient populations. Although EBCT appears to predict combined and hard coronary outcomes similarly in high risk, asymptomatic populations, these results should be interpreted with caution. Further study is needed on the incremental value of EBCT over conventional risk prediction before this test is used in screening asymptomatic populations.
电子束计算机断层扫描（EBCT）对冠心病预后，尤其是严重冠心病预后（心肌梗死或死亡）的预测能力，在无症状人群中受到了质疑。我们的目的是综合关于使用EBCT确定无症状人群心血管预后的数据。采用标准的系统评价方法来识别研究。感兴趣的结局是心肌梗死或猝死的相对风险，以及包括血运重建在内的综合事件。9篇文章符合纳入标准，其中5篇为独立研究。使用荟萃分析技术来综合预后数据，如果钙化积分高于中位数积分，则非致命性心肌梗死或死亡或血运重建综合结局的风险增加（汇总风险比8.7，95%置信区间2.7至28.1）。同样，严重事件（心肌梗死或死亡）的风险也增加（汇总风险比4.2，95%置信区间1.6至11.3）。然而，研究的质量和患者人群存在显著异质性。尽管在高危无症状人群中，EBCT似乎对综合和严重冠心病结局具有相似的预测能力，但对这些结果的解释应谨慎。在将该检查用于筛查无症状人群之前，需要进一步研究EBCT相对于传统风险预测的增量价值。
