The Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, New York, USA.
Am J Cardiol. 2011 Jan;107(1):17-23. doi: 10.1016/j.amjcard.2010.08.037.
Early and accurate triage of patients with possible ischemic chest pain remains challenging in the emergency department because current risk stratification techniques have significant cost and limited availability. The aim of this study was to determine the diagnostic value of the coronary artery calcium score (CACS) for the detection of obstructive coronary artery disease (CAD) in low- to intermediate-risk patients evaluated in the emergency department for suspected acute coronary syndromes. A total of 225 patients presenting to the emergency department with acute chest pain and Thrombolysis In Myocardial Infarction (TIMI) scores <4 who underwent non-contrast- and contrast-enhanced coronary computed tomographic angiography were included. CACS was calculated from the noncontrast scan using the Agatston method. The prevalence of obstructive CAD (defined from the contrast scan as ≥ 50% maximal reduction in luminal diameter in any segment) was 9% and increased significantly with higher scores (p <0.01 for trend). CACS of 0 were observed in 133 patients (59%), of whom only 2 (1.5%) had obstructive CAD. The diagnostic accuracy of CACS to detect obstructive CAD was good, with an area under the receiver-operating characteristic curve of 0.88 and a negative predictive value of 99% for a CACS of 0. In a multivariate model, CACS was independently associated with obstructive CAD (odds ratio 7.01, p = 0.02) and provided additional diagnostic value over traditional CAD risk factors. In conclusion, CACS appears to be an effective initial tool for risk stratification of low- to intermediate-risk patients with possible acute coronary syndromes, on the basis of its high negative predictive value and additive diagnostic value.
在急诊科，早期准确地对可能患有缺血性胸痛的患者进行分诊仍然具有挑战性，因为目前的风险分层技术成本高且可用性有限。本研究旨在确定冠状动脉钙评分（CACS）在急诊科评估疑似急性冠状动脉综合征的低至中危患者中检测阻塞性冠状动脉疾病（CAD）的诊断价值。共有 225 名因急性胸痛和 TIMI 评分<4 而就诊于急诊科的患者接受了非对比增强和对比增强冠状动脉计算机断层扫描血管造影检查。使用 Agatston 方法从非对比扫描中计算 CACS。阻塞性 CAD 的患病率（根据对比扫描定义为任何节段的管腔直径最大减少≥50%）为 9%，并随评分升高而显著增加（趋势 p<0.01）。CACS 为 0 的患者有 133 名（59%），其中仅 2 名（1.5%）有阻塞性 CAD。CACS 检测阻塞性 CAD 的诊断准确性较好，ROC 曲线下面积为 0.88，CACS 为 0 时的阴性预测值为 99%。在多变量模型中，CACS 与阻塞性 CAD 独立相关（优势比 7.01，p=0.02），并且比传统 CAD 危险因素提供了额外的诊断价值。总之，CACS 似乎是一种有效的初始工具，可用于对可能患有急性冠状动脉综合征的低至中危患者进行风险分层，基于其高阴性预测值和附加诊断价值。
