Williams Marcus, Shaw Leslee J, Raggi Paolo, Morris Douglas, Vaccarino Viola, Liu Sandy T, Weinstein Steven R, Mosler Tristen P, Tseng Philip H, Flores Ferdinand R, Nasir Khurram, Budoff Matthew
Emory University School of Medicine, Atlanta, Georgia 30306, USA.
JACC Cardiovasc Imaging. 2008 Jan;1(1):61-9. doi: 10.1016/j.jcmg.2007.09.001.
This study sought to evaluate the long-term prognostic value of the number and sites of calcified coronary lesions and to compare the accuracy of number of calcified lesions with the extent of total calcium score.
There is a strong relationship between mortality and total coronary artery calcium (CAC) score. It is not known whether the number of calcified lesions or their location influences outcome.
A total of 14,759 asymptomatic patients were referred for evaluation of CAC scanning using electron beam tomography. Univariable and multivariable Cox proportional hazards models were developed to estimate time to all-cause mortality at, on average, 6.8 years (n = 281).
Risk-adjusted annual mortality was 0.19% (95% confidence interval 0.18% to 0.21%) for patients without any calcified lesions. For patients with >20 lesions, annual risk-adjusted mortality exceeded 2% per year. Mortality rates were significantly higher for left main lesions as compared to other coronary arteries with annual mortality rates of 1.3%, 2.1%, 9.2%, and 13.6% for 1 to 2, 3 to 5, and > or =6 lesions, respectively (p < 0.0001). For left main CAC scores of 0 to 10, 11 to 100, 101 to 399, and 400 to 999, annual risk-adjusted mortality was 0.33%, 0.81%, 1.73%, and 7.71%, respectively (p < 0.0001). All 4 patients with a CAC score of > or =1,000 in the left main died during follow-up. However, patients with more frequent calcified lesions also had higher CAC scores. Specifically, > or =81% of patients with >10 calcified lesions also had a CAC score > or =100. With exception, for patients with CAC scores > or =1,000, annual mortality was dramatically higher at 3.0% to 4.5% for those with 1 to 5 calcified lesions as compared with 1.1% to 2.0% for those with 6 or more lesions (p < 0.0001).
We report that mortality rates increased proportionally with the number of calcified lesions. Although predictive information is contained in the number of calcified lesions, its added statistical value is minimal. With exception, patients with frequent lesions in the left main or those with a few large calcified lesions have a particularly high mortality risk.
本研究旨在评估冠状动脉钙化病变的数量和部位的长期预后价值，并比较钙化病变数量与总钙评分范围的准确性。
死亡率与冠状动脉总钙化（CAC）评分之间存在密切关系。尚不清楚钙化病变的数量或其位置是否会影响预后。
共有14759例无症状患者接受电子束断层扫描评估CAC。建立单变量和多变量Cox比例风险模型，以估计平均6.8年（n = 281）的全因死亡率。
无任何钙化病变的患者经风险调整后的年死亡率为0.19%（95%置信区间0.18%至0.21%）。对于有超过20个病变的患者，经风险调整后的年死亡率超过每年2%。左主干病变患者的死亡率显著高于其他冠状动脉，1至2个、3至5个以及≥6个病变的年死亡率分别为1.3%、2.1%、9.2%和13.6%（p < 0.0001）。对于左主干CAC评分为0至10、11至100、101至399以及400至999的患者，经风险调整后的年死亡率分别为0.33%、0.81%、1.73%和7.71%（p < 0.0001）。左主干CAC评分≥1000的所有4例患者在随访期间死亡。然而，钙化病变更频繁的患者也有更高的CAC评分。具体而言，有超过10个钙化病变的患者中≥81%的CAC评分≥100。例外的是，对于CAC评分≥1000的患者，有1至5个钙化病变的患者年死亡率显著更高，为3.0%至4.5%，而有6个或更多病变的患者为1.1%至2.0%（p < 0.0001）。
我们报告死亡率随钙化病变数量成比例增加。虽然钙化病变数量包含预测信息，但其额外的统计价值极小。例外的是，左主干有频繁病变的患者或有少数大钙化病变的患者有特别高的死亡风险。
