Nephrology, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium.
Nephrol Dial Transplant. 2010 Nov;25(11):3773-8. doi: 10.1093/ndt/gfq268. Epub 2010 May 25.
Coronary artery calcification (CAC) independently predicts cardiovascular events (CVE) in the general population. Whether this applies to renal transplant recipients (RTR) is unknown. This prospective study assessed the prognostic impact of CAC on CVE in RTR.
We followed up a published cohort of 281 prevalent RTR. At baseline, 16-slice chest spiral computerized tomography scan was performed and classical as well as CKD-related risk factors were recorded. Major CVE (MCVE) was defined as cardiovascular death, myocardial infarction, stroke or transient ischaemic attack. All CVE (ACVE) included MCVE and revascularizations. Prognostic factors were assessed by univariate and multivariate Cox regression.
During 2.3 ± 0.5 years of follow-up, 16 patients died from CV (n = 8) or non-CV causes (n = 8). Thirty-one RTR developed at least one CVE (first CVE cardiac in 15, peripheral in 12 and cerebrovascular in 4) for a total of 36 CVE. Thirty-month CV survival, MCVE-free survival and ACVE-free survival was 96.4, 93.9 and 87.9%, respectively. By multivariate analysis, the independent predictors of ACVE were CAC score (hazards ratios [HR] = 1.40 [1.12; 1.75] for a 2.72-fold increase in CAC, P < 0.003) and history of CVE (HR = 2.76 [1.21; 6.39], P < 0.02).
Our study shows for the first time that CAC is a strong independent predictor of CVE in RTR.
冠状动脉钙化（CAC）可独立预测普通人群中的心血管事件（CVE）。但这是否适用于肾移植受者（RTR）尚不清楚。本前瞻性研究评估了 CAC 对 RTR 中 CVE 的预后影响。
我们随访了一项已发表的 281 例现患 RTR 队列。在基线时，进行了 16 排胸部螺旋计算机断层扫描，并记录了经典和 CKD 相关的危险因素。主要心血管事件（MCVE）定义为心血管死亡、心肌梗死、卒中和短暂性脑缺血发作。所有心血管事件（ACVE）包括 MCVE 和血运重建。通过单变量和多变量 Cox 回归评估预后因素。
在 2.3 ± 0.5 年的随访期间，有 16 名患者因 CV（n = 8）或非 CV 原因（n = 8）死亡。31 名 RTR 至少发生了一次 CVE（首次 CVE 心脏 15 例，外周 12 例，脑血管 4 例），共发生 36 次 CVE。30 个月的 CV 生存率、MCVE 无事件生存率和 ACVE 无事件生存率分别为 96.4%、93.9%和 87.9%。多变量分析显示，ACVE 的独立预测因素为 CAC 评分（风险比[HR] = 1.40 [1.12；1.75]，CAC 增加 2.72 倍，P < 0.003）和 CVE 病史（HR = 2.76 [1.21；6.39]，P < 0.02）。
本研究首次表明，CAC 是 RTR 中 CVE 的一个强有力的独立预测因素。
