Becker Alexander, Leber Alexander W, Becker Christoph, von Ziegler Franz, Tittus Janine, Schroeder Ines, Steinbeck Gerhard, Knez Andreas
Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany.
BMC Cardiovasc Disord. 2008 Oct 10;8:27. doi: 10.1186/1471-2261-8-27.
To establish an efficient prophylaxis of coronary artery disease reliable risk stratification is crucial, especially in the high risk population of patients suffering from diabetes mellitus. This prospective study determined the predictive value of coronary calcifications for future cardiovascular events in asymptomatic patients with diabetes mellitus.
We included 716 patients suffering from diabetes mellitus (430 men, 286 women, age 55.2+/-15.2 years) in this study. On study entry all patients were asymptomatic and had no history of coronary artery disease. In addition, all patients showed no signs of coronary artery disease in ECG, stress ECG or echocardiography. Coronary calcifications were determined with the Imatron C 150 XP electron beam computed tomograph. For quantification of coronary calcifications we calculated the Agatston score. After a mean observation period of 8.1+/-1.1 years patients were contacted and the event rate of cardiac death (CD) and myocardial infarction (MI) was determined.
During the observation period 40 patients suffered from MI, 36 patients died from acute CD. The initial Agatston score in patients that suffered from MI or died from CD (475+/-208) was significantly higher compared to those without cardiac events (236+/-199, p<0.01). An Agatston score above 400 was associated with a significantly higher annualised event rate for cardiovascular events (5.6% versus 0.7%, p<0.01). No cardiac events were observed in patients with exclusion of coronary calcifications. Compared to the Framingham risk score and the UKPDS score the Agatston score showed a significantly higher diagnostic accuracy in the prediction of MI with an area under the ROC curve of 0.77 versus 0.68, and 0.71, respectively, p<0.01.
By determination of coronary calcifications patients at risk for future MI and CD could be identified within an asymptomatic high risk group of patients suffering from diabetes mellitus. On the other hand future events could be excluded in patients without coronary calcifications.
为了建立有效的冠心病预防措施，可靠的风险分层至关重要，尤其是在糖尿病高危患者群体中。这项前瞻性研究确定了无症状糖尿病患者冠状动脉钙化对未来心血管事件的预测价值。
本研究纳入了716例糖尿病患者（430例男性，286例女性，年龄55.2±15.2岁）。研究开始时，所有患者均无症状且无冠心病病史。此外，所有患者在心电图、运动心电图或超声心动图检查中均未显示冠心病迹象。使用Imatron C 150 XP电子束计算机断层扫描仪测定冠状动脉钙化情况。为了量化冠状动脉钙化，我们计算了阿加斯顿积分。在平均8.1±1.1年的观察期后，与患者取得联系并确定心源性死亡（CD）和心肌梗死（MI）的事件发生率。
在观察期内，40例患者发生心肌梗死，36例患者死于急性心源性死亡。发生心肌梗死或死于心源性死亡的患者初始阿加斯顿积分（475±208）显著高于无心脏事件的患者（236±199，p<0.01）。阿加斯顿积分高于400与心血管事件的年化发生率显著升高相关（5.6%对0.7%，p<0.01）。排除冠状动脉钙化的患者未观察到心脏事件。与弗明汉风险评分和英国前瞻性糖尿病研究（UKPDS）评分相比，阿加斯顿积分在预测心肌梗死方面显示出显著更高的诊断准确性，其ROC曲线下面积分别为0.77，而弗明汉风险评分为0.68，UKPDS评分为0.71，p<0.01。
通过测定冠状动脉钙化，可在无症状糖尿病高危患者群体中识别出未来发生心肌梗死和心源性死亡风险的患者。另一方面，无冠状动脉钙化的患者可排除未来发生此类事件的可能性。
