Nair Deepu, Carrigan Thomas P, Curtin Ronan J, Popovic Zoran B, Kuzmiak Stacie, Schoenhagen Paul, Flamm Scott D, Desai Milind Y
Department of Cardiovascular Medicine, Cardiovascular Imaging Laboratory, Cleveland Clinic, Cleveland, Ohio, USA.
Am J Cardiol. 2008 Aug 1;102(3):316-20. doi: 10.1016/j.amjcard.2008.03.058. Epub 2008 May 14.
Framingham risk score is an office-based tool used for long-term coronary heart disease risk stratification. Most acute coronary events occur in association with proximal nonobstructive atherosclerotic plaque. Multislice computed tomography detects both obstructive coronary artery disease (CAD) and proximal atherosclerotic plaque with high accuracy. The association of Framingham risk score with obstructive CAD and proximal atherosclerotic plaque was tested. Coronary multislice computed tomography was performed in 295 patients (61% men, mean age 54 +/- 13 years) without documented CAD referred for evaluation of cardiac symptoms. Framingham risk score was computed and patients were stratified according to 10-year risk (n = 213 [72%] low, n = 74 [25%] intermediate, and n = 8 [3%] high). Obstructive CAD was defined as > or =50% stenosis in > or =1 epicardial coronary artery. Proximal atherosclerotic plaque was defined as calcified or noncalcified plaque in the left main or proximal left anterior descending artery. In the low- and intermediate-Framingham risk score groups, there was a high frequency of proximal atherosclerotic plaque (44% and 75%) and obstructive CAD (16% and 34%), although both findings were more prevalent in the high-Framingham risk score group (63% for atherosclerotic plaque, 88% for obstructive CAD), respectively. Proximal atherosclerotic plaque was noncalcified in approximately 13 of patients. In women (n = 114) and younger (<55 years) patients (n = 148), most (93% and 91%, respectively) had a low Framingham risk score. There were 48 women and 51 younger patients with proximal atherosclerotic plaque, of whom only 40% (in each group) were on statin therapy. In conclusion, of patients with a low and intermediate Framingham risk score, a significant proportion had proximal atherosclerotic plaque or obstructive CAD.
弗雷明汉风险评分是一种用于长期冠心病风险分层的门诊工具。大多数急性冠脉事件与近端非阻塞性动脉粥样硬化斑块相关。多层计算机断层扫描能高精度检测阻塞性冠状动脉疾病（CAD）和近端动脉粥样硬化斑块。本研究检测了弗雷明汉风险评分与阻塞性CAD及近端动脉粥样硬化斑块之间的关联。对295例因心脏症状前来评估且无CAD记录的患者（61%为男性，平均年龄54±13岁）进行了冠状动脉多层计算机断层扫描。计算弗雷明汉风险评分，并根据10年风险将患者分层（低风险n = 213例[72%]，中风险n = 74例[25%]，高风险n = 8例[3%]）。阻塞性CAD定义为≥1支心外膜冠状动脉狭窄≥50%。近端动脉粥样硬化斑块定义为左主干或近端左前降支动脉中的钙化或非钙化斑块。在低弗雷明汉风险评分组和中弗雷明汉风险评分组中，近端动脉粥样硬化斑块（分别为44%和75%）及阻塞性CAD（分别为16%和34%）的发生率较高，尽管这两项结果在高弗雷明汉风险评分组中更为普遍（动脉粥样硬化斑块为63%，阻塞性CAD为88%）。近端动脉粥样硬化斑块约13%的患者为非钙化斑块。在女性患者（n = 114）和年龄较小（<55岁）的患者（n = 148）中，大多数（分别为93%和91%）的弗雷明汉风险评分为低风险。有48名女性和51名年龄较小的患者存在近端动脉粥样硬化斑块，其中只有40%（每组）接受他汀类药物治疗。总之，在弗雷明汉风险评分为低风险和中风险的患者中，相当一部分存在近端动脉粥样硬化斑块或阻塞性CAD。
