Department of Cardiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
J Nucl Cardiol. 2011 Oct;18(5):904-11. doi: 10.1007/s12350-011-9425-5. Epub 2011 Jul 19.
Cardiologists are often confronted with patients presenting with chest pain, in whom clinical risk profiling is required. We studied four frequently used risk scores in their ability to predict for coronary artery disease (CAD) and major adverse cardiovascular events in patients presenting with stable chest pain at the cardiology outpatient clinic.
We enrolled 1,296 stable chest pain patients, who underwent cardiac computed tomographic angiography (CCTA) to assess CAD (any, significant: stenosis ≥50%). Framingham (FRS), PROCAM, SCORE risk score, and Diamond Forrester pre-test probability were calculated. All patients were followed up for a mean 19 ± 9 months for all cardiovascular events (mortality, acute coronary syndrome, revascularization >90 days after CCTA). In ROC-analysis for prediction of significant CAD, the areas under the curve for FRS; 0.68 (95% confidence interval: 0.64-0.72) and for SCORE; 0.69 (95% confidence interval: 0.65-0.72) were significantly higher than for PROCAM; 0.64 (95% confidence interval: 0.61-0.68; P ≤ .001), as well as marginally higher than for Diamond Forrester; 0.65 (95% confidence interval: 0.61-0.68; P ≤ .05). Low FRS category showed the lowest number of patients with significant CAD, compared to patients with low risk using PROCAM, SCORE or Diamond Forrester (P < .001). Also, low FRS category showed less events (compared to PROCAM and SCORE; P < .001, for Diamond Forrester; P = .14).
Our data show that in a stable chest pain population, the ability of FRS and SCORE to predict for CAD was similar and better compared to PROCAM and Diamond Forrester. The number of low risk patients showing significant CAD or events was lower using FRS. Consequently, risk categorization using FRS seems to be safest to stratify stable chest pain patients prior to CCTA.
心脏病专家经常会遇到胸痛患者，需要对其进行临床风险评估。我们研究了四种常用于预测稳定型胸痛患者冠状动脉疾病（CAD）和主要心血管不良事件的风险评分。
我们纳入了 1296 例稳定型胸痛患者，他们接受了心脏计算机断层扫描血管造影（CCTA）以评估 CAD（任何程度，显著：狭窄≥50%）。计算了Framingham（FRS）、PROCAM、SCORE 风险评分和 Diamond Forrester 术前概率。所有患者平均随访 19±9 个月，以观察所有心血管事件（死亡率、急性冠脉综合征、CCTA 后 90 天以上的血运重建）。在预测显著 CAD 的 ROC 分析中，FRS 的曲线下面积为 0.68（95%置信区间：0.64-0.72），SCORE 为 0.69（95%置信区间：0.65-0.72），显著高于 PROCAM（0.64；95%置信区间：0.61-0.68；P≤0.001），略高于 Diamond Forrester（0.65；95%置信区间：0.61-0.68；P≤0.05）。与使用 PROCAM、SCORE 或 Diamond Forrester 的低风险患者相比，FRS 低风险患者中 CAD 发生率最低（P<0.001）。而且，FRS 低风险患者的事件发生率也较低（与 PROCAM 和 SCORE 相比，P<0.001；与 Diamond Forrester 相比，P=0.14）。
我们的数据表明，在稳定型胸痛人群中，FRS 和 SCORE 预测 CAD 的能力与 PROCAM 和 Diamond Forrester 相似，且优于后者。使用 FRS 的低危患者中，出现显著 CAD 或事件的患者数量更少。因此，在 CCTA 前，使用 FRS 进行风险分层似乎是最安全的方法，可以对稳定型胸痛患者进行分层。
