冠状动脉钙化覆盖评分：动脉粥样硬化多民族研究中的测定、相关性及预测准确性

Coronary calcium coverage score: determination, correlates, and predictive accuracy in the Multi-Ethnic Study of Atherosclerosis.

作者信息

Brown Elizabeth R, Kronmal Richard A, Bluemke David A, Guerci Alan D, Carr J Jeffrey, Goldin Jonathan, Detrano Robert

机构信息

Department of Biostatistics, University of Washington, F-600 Health Sciences Bldg, 1705 NE Pacific St, Seattle, WA 98195-7232, USA.

出版信息

Radiology. 2008 Jun;247(3):669-75. doi: 10.1148/radiol.2473071469. Epub 2008 Apr 15.

DOI:10.1148/radiol.2473071469

PMID:18413889

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5410932/

Abstract

PURPOSE

To develop a new calcium score for use with unenhanced cardiac computed tomography (CT) that can be used to define the percentage of coronary arteries affected by calcium and to correlate this score with risk factors and cardiovascular events.

MATERIALS AND METHODS

Institutional review boards at all participating centers approved this HIPAA-compliant study, and all participants gave written informed consent. Calcium coverage score (CCS), which represents the percentage of coronary arteries affected by calcific plaque, was calculated for 3252 participants in the Multi-Ethnic Study of Atherosclerosis in whom calcific plaque was detected with CT. Quasi-Poisson models were used to estimate associations (assessed by using t tests with robust standard errors) between CCS and risk factors. Associations between the CCS, Agatston, and calcium mass scores (hereafter, mass scores) and outcomes were estimated and assessed by using Cox proportional hazards models with Wald tests. The predictive ability of these models was assessed by using area under the receiver operating characteristic curves and bootstrap t tests.

RESULTS

After adjustments were made for age, race, ethnicity, and sex in the quasi-Poisson model, CCS was associated with hypertension, dyslipidemia, and diabetes (P < .001 for all diseases). After adjustments for age and sex, a twofold increase in CCS was associated with a 52% (95% confidence interval: 34%, 72%) increase in risk for any coronary heart disease (CHD) event. When Agatston or mass scores were included with CCS in a Cox model for prediction of CHD events, neither Agatston score nor mass score was a significant predictor, whereas CCS remained significantly associated with CHD events. Although receiver operating characteristic curves suggested that there was a difference between CCS score and Agatston and mass scores in prediction of a cardiac event, no differences in prediction of hard cardiac events (myocardial infarction, death) were found.

CONCLUSION

Both spatial distribution and amount of calcified plaque contribute to risk for CHD.

摘要

目的

开发一种用于非增强心脏计算机断层扫描（CT）的新钙评分，该评分可用于定义受钙化影响的冠状动脉百分比，并将此评分与风险因素及心血管事件相关联。

材料与方法

所有参与中心的机构审查委员会批准了这项符合健康保险流通与责任法案（HIPAA）的研究，所有参与者均签署了书面知情同意书。为动脉粥样硬化多民族研究中3252名通过CT检测到钙化斑块的参与者计算了钙覆盖评分（CCS），该评分代表受钙化斑块影响的冠状动脉百分比。使用拟泊松模型估计CCS与风险因素之间的关联（通过使用具有稳健标准误的t检验进行评估）。使用带有Wald检验的Cox比例风险模型估计并评估CCS、阿加斯顿评分和钙质量评分（以下简称质量评分）与结局之间的关联。通过使用受试者工作特征曲线下面积和自抽样t检验评估这些模型的预测能力。

结果

在拟泊松模型中对年龄、种族、民族和性别进行调整后，CCS与高血压、血脂异常和糖尿病相关（所有疾病的P均<0.001）。在对年龄和性别进行调整后，CCS增加两倍与任何冠心病（CHD）事件风险增加52%（95%置信区间：34%，72%）相关。当在预测CHD事件的Cox模型中将阿加斯顿评分或质量评分与CCS一起纳入时，阿加斯顿评分和质量评分均不是显著预测因子，而CCS仍与CHD事件显著相关。尽管受试者工作特征曲线表明在预测心脏事件方面CCS评分与阿加斯顿评分和质量评分之间存在差异，但在预测严重心脏事件（心肌梗死、死亡）方面未发现差异。