Department of Emergency Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Mayo Clin Proc. 2010 Apr;85(4):314-22. doi: 10.4065/mcp.2009.0620.
To determine the long-term outcome of computed tomographic (CT) quantification of coronary artery calcium (CAC) used as a triage tool for patients presenting with chest pain to an emergency department (ED).
Patients (men aged 30-62 years and women aged 30-65 years) with chest pain and low-to-moderate probability of coronary artery disease underwent both conventional ED chest pain evaluation and CT CAC assessment prospectively. Patients' physicians were blinded to the CAC results. The results of the conventional evaluation were compared with CAC findings on CT, and the long-term outcome in patients undergoing CT CAC assessment was established. Primary end points (acute coronary syndrome, death, fatal or nonfatal non-ST-segment elevation myocardial infarction, fatal or nonfatal ST-segment elevation myocardial infarction) and secondary outcomes (coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, coronary stenting, or a combination thereof) were obtained when the patient was dismissed from the ED or hospital and then at 30 days, 1 year, and 5 years.
Of the 263 study patients, 133 (51%) had a CAC score of zero. This absence of CAC correlated strongly with the likelihood of noncardiac chest pain. Among 133 patients with a CAC score of zero, only 1 (<1%) had cardiac chest pain. Conversely, of the 31 patients shown to have cardiac chest pain, 30 (97%) had evidence of CAC on CT. When a CAC cutoff score of 36 was used, as suggested by receiver operating characteristic analysis, sensitivity was 90%; specificity, 85%; positive predictive value, 44%; and negative predictive value, 99%. During long-term follow-up, patients without CAC experienced no cardiac events at 30 days, 1 year, and 5 years.
Findings suggest that CT CAC assessment is a powerful adjunct in chest pain evaluation for the population at low-to-intermediate risk. Absent or minimal CAC in this population makes cardiac chest pain extremely unlikely. The absence of CAC suggests an excellent long-term (5-year) prognosis, with no primary or secondary cardiac outcomes occurring in study patients at 5-year follow-up.
确定计算机断层扫描（CT）定量冠状动脉钙化（CAC）作为急诊科胸痛患者分诊工具的长期结果。
前瞻性纳入胸痛且低至中度冠状动脉疾病可能性的患者（年龄 30-62 岁的男性和年龄 30-65 岁的女性），并同时接受常规急诊科胸痛评估和 CT CAC 评估。患者的医生对 CAC 结果不知情。将常规评估的结果与 CT 上的 CAC 结果进行比较，并确定接受 CT CAC 评估的患者的长期结果。主要终点（急性冠状动脉综合征、死亡、致死性或非致死性非 ST 段抬高型心肌梗死、致死性或非致死性 ST 段抬高型心肌梗死）和次要终点（冠状动脉旁路移植术、经皮腔内冠状动脉血管成形术、冠状动脉支架植入术或联合治疗）在患者从急诊科或医院出院时以及 30 天、1 年和 5 年时获得。
在 263 名研究患者中，133 名（51%）的 CAC 评分为零。这种无 CAC 评分与非心源性胸痛的可能性密切相关。在 133 名 CAC 评分为零的患者中，只有 1 名（<1%）患有心源性胸痛。相反，在 31 名被诊断有心源性胸痛的患者中，30 名（97%）在 CT 上有 CAC 证据。当使用受试者工作特征分析建议的 36 分 CAC 截断值时，灵敏度为 90%；特异性为 85%；阳性预测值为 44%；阴性预测值为 99%。在长期随访中，无 CAC 的患者在 30 天、1 年和 5 年均未发生心脏事件。
研究结果表明，CT CAC 评估是低至中度风险人群胸痛评估的有力辅助手段。在该人群中，无 CAC 或 CAC 极少使心源性胸痛极不可能发生。无 CAC 提示具有极好的长期（5 年）预后，在 5 年随访中，研究患者未发生主要或次要心脏结局。
