冠状动脉钙含量检测对阻塞性疾病的诊断准确性：ACCURACY 试验结果。
Diagnostic accuracy of coronary artery calcium for obstructive disease: results from the ACCURACY trial.
机构信息
Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA.
出版信息
Int J Cardiol. 2013 Jun 20;166(2):505-8. doi: 10.1016/j.ijcard.2011.11.031. Epub 2011 Dec 26.
BACKGROUND
Although numerous trials have demonstrated the diagnostic accuracy of coronary artery calcium (CAC) scanning for prediction of obstructive disease, virtually all studies have been performed using Electron Beam CT (EBCT). We evaluated the diagnostic accuracy of CAC by 64-row CT to detect obstructive coronary stenosis compared to quantitative coronary angiography (QCA) in the ACCURACY multicenter trial.
METHODS
16 sites prospectively enrolled 230 patients (pts) [59.5% males, 57yrs] with chest pain referred for invasive coronary angiography (ICA). Pts underwent CAC scan and CT angiography prior to ICA. Total CAC scores were correlated with angiographically documented stenoses using common cutpoints of CAC >0, >100 and >400. Significant obstructive disease was defined as >50% luminal stenosis by QCA.
RESULTS
The per-patient accuracy of CAC by 64-row CT compared to QCA demonstrates a high sensitivity and low specificity for the presence of obstructive disease (>50% stenosis on QCA). With CAC >0, >100 and >400, the sensitivities to predict stenosis were 98%, 88%, and 60%, whereas the specificities were 42%, 71%, and 88%, respectively.
CONCLUSIONS
Most previous CAC studies have focused on the fact that significant calcium places patients into a higher risk group in terms of future events, and should lead to more aggressive treatment with preventative therapies. This prospective multicenter results comparing 64-row CAC to QCA demonstrate that CAC using 64-row CT scanner, similar to previously published reports using EBCT, is highly sensitive and moderately specific test to predict significant coronary artery stenosis. The presence of abnormal levels of calcium may place patients into a higher risk group in terms of future events, and lead to more aggressive treatment with preventative therapies. However, the detection of calcium does not always help with a clinical diagnosis particularly in the presence of diffuse moderate coronary atheroma. Whether this information is complementary to CTA data remains to be validated.
背景
虽然许多试验已经证明了冠状动脉钙（CAC）扫描在预测阻塞性疾病方面的诊断准确性，但几乎所有研究都是使用电子束 CT（EBCT）进行的。我们通过 64 排 CT 评估 CAC 对阻塞性冠状动脉狭窄的诊断准确性，与 ACCURACY 多中心试验中的定量冠状动脉造影（QCA）进行比较。
方法
16 个地点前瞻性地招募了 230 名（59.5%为男性，57 岁）胸痛患者，这些患者因疑似冠心病而行有创冠状动脉造影（ICA）检查。患者在 ICA 前接受 CAC 扫描和 CT 血管造影。使用 CAC>0、>100 和>400 的常见切点，将总 CAC 评分与血管造影记录的狭窄程度相关联。通过 QCA 确定 >50%的管腔狭窄定义为有意义的阻塞性疾病。
结果
与 QCA 相比，64 排 CT 每例患者 CAC 的准确性显示出存在阻塞性疾病（QCA 上>50%狭窄）的高敏感性和低特异性。当 CAC>0、>100 和>400 时，预测狭窄的敏感性分别为 98%、88%和 60%，而特异性分别为 42%、71%和 88%。
结论
大多数以前的 CAC 研究都集中在这样一个事实，即大量的钙使患者处于未来事件的更高风险组中，应该用预防性治疗进行更积极的治疗。这项比较 64 排 CT 与 QCA 的前瞻性多中心结果表明，64 排 CT 扫描仪的 CAC 与以前使用 EBCT 发表的报告类似，是一种高度敏感和中度特异性的测试，可预测显著的冠状动脉狭窄。异常水平的钙可能使患者处于未来事件的更高风险组中，并导致用预防性治疗进行更积极的治疗。然而，钙的检测并不总是有助于临床诊断，特别是在存在弥漫性中度冠状动脉粥样硬化的情况下。这种信息是否与 CTA 数据互补仍有待验证。
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