Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
Eur Heart J. 2012 Dec;33(23):2955-62. doi: 10.1093/eurheartj/ehs230. Epub 2012 Jul 26.
To determine if coronary artery calcium (CAC) scoring is independently predictive of mortality in young adults and in the elderly population and if a young person with high CAC has a higher mortality risk than an older person with less CAC.
We studied a cohort of 44 052 asymptomatic patients referred for CAC scans for cardiovascular risk stratification. All-cause mortality rates (MRs) were calculated after stratifying by age groups (<45, 45-54, 55-64, 65-74, and ≥75) and CAC score (0, 1-100, 100-400, and >400). Multivariable Cox regression models were constructed to assess the independent value of CAC for predicting all-cause mortality in the <45- and ≥75-year-old age groups. The MR increased in both the <45- and ≥75-year-old age groups with an increasing CAC group. After multivariable adjustment, increasing CAC remained independently predictive of increased mortality compared with CAC = 0 [<45 age group, hazard ratio (95% confidence interval): CAC = 1-100, 2.3 (1.2-4.2); CAC = 100-400, 7.4 (3.3-16.6); CAC > 400, 34.6 (15.5-77.4); ≥75 age group: CAC = 1-100, 7.0 (2.4-20.8); CAC = 100-400, 9.2 (3.2-26.5); CAC > 400, 16.1 (5.8-45.1)]. Persons <45 years old with CAC = 100-400 and CAC > 400 had 2- and 10-fold increased MRs, respectively, compared with persons ≥75 with no CAC. Individuals ≥75 years old with CAC = 0 had a 5.6-year survival rate of 98%, similar to those in other age groups with CAC = 0 (5.6-year survival, 99%).
The value of CAC for predicting mortality extends to both elderly patients and those <45 years old. Elderly persons with no CAC have a lower MR than younger persons with high CAC.
确定冠状动脉钙（CAC）评分是否可独立预测年轻人和老年人的死亡率，以及 CAC 较高的年轻人的死亡率是否高于 CAC 较低的老年人。
我们研究了一个 44052 名无症状患者的队列，这些患者因心血管风险分层而接受 CAC 扫描。根据年龄组（<45 岁、45-54 岁、55-64 岁、65-74 岁和≥75 岁）和 CAC 评分（0、1-100、100-400 和>400）分层后，计算全因死亡率（MR）。构建多变量 Cox 回归模型以评估 CAC 在<45 岁和≥75 岁年龄组中预测全因死亡率的独立价值。随着 CAC 组的增加，<45 岁和≥75 岁年龄组的 MR 均增加。经过多变量调整后，与 CAC=0 相比，CAC 持续升高与死亡率升高独立相关[<45 岁年龄组：CAC=1-100，2.3（1.2-4.2）；CAC=100-400，7.4（3.3-16.6）；CAC>400，34.6（15.5-77.4）；≥75 岁年龄组：CAC=1-100，7.0（2.4-20.8）；CAC=100-400，9.2（3.2-26.5）；CAC>400，16.1（5.8-45.1）]。CAC=100-400 和 CAC>400 的<45 岁患者的 MR 分别增加 2 倍和 10 倍，而 CAC=0 的≥75 岁患者的 MR 则相似。CAC=0 的≥75 岁患者的 5.6 年生存率为 98%，与 CAC=0 的其他年龄组相似（5.6 年生存率，99%）。
CAC 预测死亡率的价值适用于老年患者和<45 岁的患者。无 CAC 的老年患者的死亡率低于 CAC 较高的年轻患者。
