Johnson Kevin M, Dowe David A, Brink James A
Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St., New Haven, CT 06520, USA.
AJR Am J Roentgenol. 2009 Jan;192(1):235-43. doi: 10.2214/AJR.08.1056.
The objective of our study was to determine the degree to which Framingham risk estimates and the National Cholesterol Education Program (NCEP) Adult Treatment Panel III core risk categories correlate with total coronary atherosclerotic plaque burden (calcified and noncalcified) as estimated on coronary CT angiograms.
Coronary CT angiography was performed in 1,653 patients (1,089 men, 564 women) without a history of coronary heart disease (mean age+/-SD: men, 51.6+/-9.7 years; women, 56.9+/-10.5 years). The most common reasons for the examination were hypercholesterolemia, family history, hypertension, smoking, and atypical chest pain. The coronary tree was divided into 16 segments; four different methods were used to quantify the amount of atherosclerotic plaque or the degree of stenosis in each segment, and segment scores were combined to give total scores. Framingham risk estimates and NCEP risk categories were calculated for each patient.
Correlation of plaque scores with the Framingham 10-year risk estimates were modest: Spearman's rho was 0.49-0.55. For all comparisons of NCEP risk categories to plaque score categories, the proportion of raw agreement, p(0), was less than 0.50. Cohen's kappa ranged from 0.18 to 0.20. Overall, 21% of the patients would have their perceived need for statins changed by using the coronary CTA plaque estimates in place of the NCEP core risk categories; 26% of the patients on statins had no detectable plaque.
Coronary risk stratification using a risk factor only-based scheme is a weak discriminator of the overall atherosclerotic plaque burden in individual patients. Patients with little or no plaque might be subjected to lifelong drug therapy, whereas many others with substantial plaque might be undertreated or not treated at all.
我们研究的目的是确定弗雷明汉风险评估以及美国国家胆固醇教育计划（NCEP）成人治疗专家组第三次报告的核心风险类别与通过冠状动脉CT血管造影术评估的冠状动脉粥样硬化斑块总负荷（钙化和非钙化）之间的关联程度。
对1653例无冠心病病史的患者（1089例男性，564例女性）进行冠状动脉CT血管造影（平均年龄±标准差：男性，51.6±9.7岁；女性，56.9±10.5岁）。检查的最常见原因是高胆固醇血症、家族病史、高血压、吸烟和非典型胸痛。冠状动脉树被分为16段；使用四种不同方法量化每段动脉粥样硬化斑块的数量或狭窄程度，并将各段得分合并得出总分。为每位患者计算弗雷明汉风险评估和NCEP风险类别。
斑块得分与弗雷明汉10年风险评估之间的相关性一般：Spearman秩相关系数为0.49 - 0.55。对于NCEP风险类别与斑块得分类别的所有比较，原始一致性比例p(0)小于0.50。Cohen's kappa系数范围为0.18至0.20。总体而言，21%的患者若使用冠状动脉CTA斑块评估代替NCEP核心风险类别，其对他汀类药物的需求认知会改变；26%正在服用他汀类药物的患者未检测到斑块。
仅基于风险因素的冠状动脉风险分层方案对个体患者总体动脉粥样硬化斑块负荷的鉴别能力较弱。几乎没有或没有斑块的患者可能会接受终身药物治疗，而许多有大量斑块的患者可能治疗不足或根本未接受治疗。
