Schmermund A, Stang A, Möhlenkamp S, Eggebrecht H, Baumgart D, Gilbert V, Grönemeyer D, Seibel R, Erbel R
Department of Cardiology, University Clinic Essen, Hufelandstrasse 55, 45122 Essen, Germany.
Z Kardiol. 2004 Sep;93(9):696-705. doi: 10.1007/s00392-004-0120-2.
The electron-beam computed tomography-(EBCT-)derived calcium score provides a measure of coronary atherosclerotic plaque disease which may allow for more precise risk stratification in symptomatic patients. However, it remains unclear if EBCT can add prognostic information compared with the clinical information derived from risk factor assessment, exercise stress testing, and coronary angiography.
A cohort of 300 consecutive patients with recent (<3 months) onset of symptoms was retrospectively identified who were examined for possible coronary artery disease (CAD) and who all underwent EBCT. Successful follow-up after 3.5 years was obtained in 255 (85%) patients whose mean age at baseline was 58+/-11 years (n = 181 (71%), males). Four clinical categories with increasing evidence of CAD were constructed on the basis of risk factor assessment, exercise stress testing, coronary angiographic anatomy, and coronary revascularization at baseline. During follow-up, major adverse cardiac events (MACE: myocardial infarction, cardiac death, revascularization) were observed in 40 (16%) patients, including myocardial infarction and cardiac death in 5 patients. The 4 clinical categories were highly predictive of MACE, with a relative risk estimate of 28.3 (95% CI, 6.7-119.1) in the upper vs. the reference category. In univariate analysis, the relative risk estimate of MACE associated with a calcium score > or =100 was 12.0 (95% CI, 4.7-30.6). After adjustment for the clinical categories and for age, this estimate decreased in multivariate analysis, but remained predictive at 4.4 (95% CI, 1.5-12.6).
In patients with first-time evaluation of possible CAD, EBCT-derived coronary calcium is suggested to provide for independent and additional information compared with the clinically available information.
电子束计算机断层扫描（EBCT）得出的钙化积分可衡量冠状动脉粥样硬化斑块疾病，这可能有助于对有症状患者进行更精确的风险分层。然而，与通过危险因素评估、运动负荷试验和冠状动脉造影得出的临床信息相比，EBCT能否增加预后信息仍不明确。
回顾性纳入300例近期（<3个月）出现症状的连续患者，这些患者因可能患有冠状动脉疾病（CAD）接受检查并均进行了EBCT检查。255例（85%）患者在3.5年后获得成功随访，其基线平均年龄为58±11岁（n = 181例（71%），男性）。根据基线时的危险因素评估、运动负荷试验、冠状动脉造影解剖结构和冠状动脉血运重建情况，构建了4个CAD证据逐渐增加的临床类别。随访期间，40例（16%）患者发生主要不良心脏事件（MACE：心肌梗死、心源性死亡、血运重建），其中5例发生心肌梗死和心源性死亡。这4个临床类别对MACE具有高度预测性，最高类别与参考类别相比，相对风险估计值为28.3（95%CI，6.7 - 119.1）。在单因素分析中，钙化积分≥100与MACE相关的相对风险估计值为12.0（95%CI，4.7 - 30.6）。在对临床类别和年龄进行调整后，该估计值在多因素分析中有所下降，但仍具有预测性，为4.4（95%CI，1.5 - 12.6）。
对于首次评估可能患有CAD的患者，与临床可用信息相比，EBCT得出的冠状动脉钙化建议可提供独立的额外信息。
Zotero 插件