Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Am Coll Cardiol. 2010 Feb 16;55(7):627-34. doi: 10.1016/j.jacc.2009.07.072.
This study was designed to evaluate whether the absence of coronary calcium could rule out >or=50% coronary stenosis or the need for revascularization.
The latest American Heart Association guidelines suggest that a calcium score (CS) of zero might exclude the need for coronary angiography among symptomatic patients.
A substudy was made of the CORE64 (Coronary Evaluation Using Multi-Detector Spiral Computed Tomography Angiography Using 64 Detectors) multicenter trial comparing the diagnostic performance of 64-detector computed tomography to conventional angiography. Patients clinically referred for conventional angiography were asked to undergo a CS scan up to 30 days before.
In all, 291 patients were included, of whom 214 (73%) were male, and the mean age was 59.3 +/- 10.0 years. A total of 14 (5%) patients had low, 218 (75%) had intermediate, and 59 (20%) had high pre-test probability of obstructive coronary artery disease. The overall prevalence of >or=50% stenosis was 56%. A total of 72 patients had CS = 0, among whom 14 (19%) had at least 1 >or=50% stenosis. The overall sensitivity for CS = 0 to predict the absence of >or=50% stenosis was 45%, specificity was 91%, negative predictive value was 68%, and positive predictive value was 81%. Additionally, revascularization was performed in 9 (12.5%) CS = 0 patients within 30 days of the CS. From a total of 383 vessels without any coronary calcification, 47 (12%) presented with >or=50% stenosis; and from a total of 64 totally occluded vessels, 13 (20%) had no calcium.
The absence of coronary calcification does not exclude obstructive stenosis or the need for revascularization among patients with high enough suspicion of coronary artery disease to be referred for coronary angiography, in contrast with the published recommendations. Total coronary occlusion frequently occurs in the absence of any detectable calcification. (Coronary Evaluation Using Multi-Detector Spiral Computed Tomography Angiography Using 64 Detectors [CORE-64]; NCT00738218).
本研究旨在评估冠状动脉钙化缺失是否可排除≥50%的冠状动脉狭窄或是否需要血运重建。
美国心脏协会最新指南建议，对于有症状的患者，如果钙评分（CS）为零，可能无需进行冠状动脉造影。
对 CORE64（使用 64 探测器的多排螺旋 CT 冠状动脉血管造影术进行的冠状动脉评估）多中心试验进行了一项亚组研究，比较了 64 排 CT 的诊断性能与常规血管造影术。临床建议行常规血管造影术的患者被要求在 30 天内进行 CS 扫描。
共纳入 291 例患者，其中 214 例（73%）为男性，平均年龄为 59.3±10.0 岁。共有 14 例（5%）患者低危、218 例（75%）患者中危、59 例（20%）患者高危存在阻塞性冠状动脉疾病。总的狭窄程度≥50%的发生率为 56%。共有 72 例患者 CS=0，其中 14 例（19%）至少存在 1 处≥50%的狭窄。CS=0 预测无≥50%狭窄的总体敏感性为 45%，特异性为 91%，阴性预测值为 68%，阳性预测值为 81%。此外，CS=0 的 9 例患者（12.5%）在 CS 后 30 天内进行了血运重建。383 处无任何冠状动脉钙化的血管中，47 处（12%）有≥50%的狭窄；64 处完全闭塞的血管中，13 处（20%）没有钙。
与已发表的建议相反，对于高度怀疑患有冠状动脉疾病而被建议进行冠状动脉造影的患者，冠状动脉钙化缺失并不能排除阻塞性狭窄或血运重建的需要。完全闭塞的冠状动脉经常在没有任何可检测到的钙化的情况下发生。（使用 64 探测器的多排螺旋 CT 冠状动脉血管造影术进行的冠状动脉评估[CORE-64]；NCT00738218）
