Rubinshtein Ronen, Gaspar Tamar, Halon David A, Goldstein Jacob, Peled Nathan, Lewis Basil S
Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Am J Cardiol. 2007 Feb 15;99(4):472-5. doi: 10.1016/j.amjcard.2006.08.060. Epub 2006 Dec 28.
We examined the extent of coronary artery disease (CAD) on 64-slice contrast-enhanced multidetector computed tomography in patients who underwent investigation of a chest pain syndrome who had a zero or low coronary calcium score (CS). In 668 consecutive patients with chest pain syndromes (39% with acute presentation, 61% with long-term presentation) who underwent cardiac multidetector computed tomography, we assessed prevalence and severity of coronary stenoses (>or=1 coronary artery stenosis with >or=50% luminal narrowing) in 231 patients (54 +/- 12 years of age, 45% women) with a 0 (n = 125) or low (n = 106) coronary CS. Obstructive (>or=50% lesion) CAD was present in 27 of 231 patients, in 9 of 125 patients (7%) with a 0 CS, in 18 of 106 (17%) with a low CS (1 to 100), and in 14 of 90 patients (16%) with an acute presentation and 13 of 141 patients (9%) with a long-term presentation (p = NS). All patients in the 0 CS group had single-vessel disease, and 9 (50%) with low CS had multivessel disease, with left main involvement in 1. Of the 27 patients with obstructive CAD on multidetector computed tomography, invasive coronary angiography confirmed these findings in 21 of 23 patients (positive predictive value 91%), and 16 (76%) of them (6.9% of the 0 CS and low CS groups) underwent a myocardial revascularization procedure after invasive coronary angiographic concordance. In conclusion, despite the high known negative predictive value of CS for coronary events, a low and even 0 CS does not exclude clinically important obstructive CAD in patients undergoing investigation of an acute or long-term chest pain syndrome. Contrast-enhanced multidetector computed tomography should be the noninvasive computed tomographic test of choice when possible in these patients.
我们在接受胸痛综合征检查且冠状动脉钙化积分（CS）为零或较低的患者中，利用64层对比增强多层螺旋计算机断层扫描来检查冠状动脉疾病（CAD）的程度。在668例连续接受心脏多层螺旋计算机断层扫描的胸痛综合征患者中（39%为急性发作，61%为长期发作），我们评估了231例（年龄54±12岁，45%为女性）冠状动脉CS为0（n = 125）或较低（n = 106）的患者中冠状动脉狭窄（≥1处冠状动脉狭窄且管腔狭窄≥50%）的患病率和严重程度。231例患者中有27例存在阻塞性（≥50%病变）CAD，冠状动脉CS为0的125例患者中有9例（7%），冠状动脉CS较低（1至100）的106例患者中有18例（17%），急性发作的90例患者中有14例（16%），长期发作的141例患者中有13例（9%）（p =无显著性差异）。冠状动脉CS为0组的所有患者均为单支血管病变，冠状动脉CS较低的患者中有9例（50%）为多支血管病变，其中1例累及左主干。在多层螺旋计算机断层扫描显示有阻塞性CAD的27例患者中，有创冠状动脉造影在23例患者中的21例证实了这些结果（阳性预测值91%），其中16例（76%）（占冠状动脉CS为0和较低组的6.9%）在有创冠状动脉造影结果一致后接受了心肌血运重建术。总之，尽管已知冠状动脉钙化积分对冠状动脉事件具有较高的阴性预测价值，但在接受急性或长期胸痛综合征检查的患者中，较低甚至为零的冠状动脉钙化积分并不能排除临床上重要的阻塞性CAD。在这些患者中，如有可能，对比增强多层螺旋计算机断层扫描应作为首选的无创计算机断层扫描检查。
