Shaw Leslee J, Raggi Paolo, Callister Tracy Q, Berman Daniel S
Cedars-Sinai Medical Center, Room 125-4, Taper Building, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA.
Eur Heart J. 2006 Apr;27(8):968-75. doi: 10.1093/eurheartj/ehi750. Epub 2006 Jan 27.
To determine the extent and prognostic significance of coronary artery calcium in asymptomatic smokers and non-smokers. Population data are available on the prognostic impact of smoking on atherosclerotic imaging measurements of the carotid and peripheral arteries. Limited data are available on the impact of cigarette smoking on the prognostic value of coronary calcium.
A referred patient registry of 10,377 asymptomatic individuals (40% were current smokers) was followed for death from all-causes at 5 years. Univariable and multivariable Cox proportional hazard models were calculated to estimate time to all-cause mortality. Cumulative 5-year survival was 96.9 and 98.4% for smokers when compared with non-smokers (P < 0.0001). Using a stratified Cox proportional hazards survival analysis, survival for non-smokers ranged from 99.7 to 89.6% with calcium score of 0-10 and >1000 (P < 0.0001). In comparison, smokers had survival rates ranging from 99.5 to 81.4% for calcium score of 0-10 to >1000 (P < 0.0001). When further evaluating the effect of age on prognosis by coronary calcium, there was an additive relationship between age and calcium that was exacerbated with smoking, resulting in higher relative risk ratios for older smokers with coronary calcium (P < 0.0001). For smokers <50 years of age, a calcium score >1000 was associated with a relative risk ratio that was elevated 8.9-fold (P = 0.029). Thus, resulting in an expected reduction in life expectancy of 4.8 years for smokers <50 years of age with a calcium score >400 (P < 0.0001).
The prognostic value of coronary artery calcium scoring was accurate in identifying a high-risk cohort of asymptomatic smokers and non-smokers. Young smokers with high-risk calcium scores have a four- to nine-fold increased risk of dying when compared with similarly aged non-smokers. When prospectively applied, evidence of a high-risk calcium score may be useful in educating patients as to their expected risk of dying over the next 5 years.
确定无症状吸烟者和非吸烟者冠状动脉钙化的程度及其预后意义。关于吸烟对颈动脉和外周动脉粥样硬化成像测量的预后影响已有人群数据。但关于吸烟对冠状动脉钙化预后价值的影响的数据有限。
对一个包含10377名无症状个体（40%为当前吸烟者）的转诊患者登记系统进行了为期5年的全因死亡随访。计算单变量和多变量Cox比例风险模型以估计全因死亡率的时间。吸烟者的5年累积生存率为96.9%，非吸烟者为98.4%（P<0.0001）。使用分层Cox比例风险生存分析，非吸烟者的生存率在钙评分0 - 10和>1000时分别为99.7%至89.6%（P<0.0001）。相比之下，吸烟者在钙评分0 - 10至>1000时的生存率为99.5%至81.4%（P<0.0001）。当进一步通过冠状动脉钙化评估年龄对预后的影响时，年龄和钙化之间存在累加关系，且吸烟会加剧这种关系，导致老年吸烟者冠状动脉钙化的相对风险比更高（P<0.0001）。对于年龄<50岁的吸烟者，钙评分>1000与相对风险比升高8.9倍相关（P = 0.029）。因此，钙评分>400的<50岁吸烟者预期寿命减少4.8年（P<0.0001）。
冠状动脉钙化评分的预后价值在识别无症状吸烟者和非吸烟者的高危队列方面是准确的。与同龄非吸烟者相比，具有高危钙评分的年轻吸烟者死亡风险增加4至9倍。前瞻性应用时，高危钙评分的证据可能有助于告知患者未来5年的预期死亡风险。
