Brigham and Women's Hospital, Boston, Massachusetts, USA.
Am J Cardiol. 2013 Feb 15;111(4):479-85. doi: 10.1016/j.amjcard.2012.10.028. Epub 2012 Dec 1.
Studies examining coronary computed tomographic angiography (CCTA) have demonstrated increased mortality related to coronary artery disease (CAD) severity but are limited to relatively nondiverse ethnic populations. The aim of this study was to evaluate the prognostic significance of CAD on CCTA according to ethnicity for patients without previous CAD in a prospective international CCTA registry of 11 sites (7 countries) who underwent 64-slice CCTA from 2005 to 2010. CAD was defined as any coronary artery atherosclerosis and obstructive CAD as ≥50% stenosis. All-cause mortality and nonfatal myocardial infarction (MI) were assessed by ethnicity using Kaplan-Meier and Cox proportional hazards, controlling for baseline risk factors, medications, and revascularization. A total of 16,451 patients of mean age 58 years (55% men) were followed over a median of 2.0 years (interquartile range 1.4 to 3.2). Patients were 60.1% Caucasian, 34.4% East Asian, and 5.5% African. Death or MI occurred in 0.5% (38 of 7,109) among patients with no CAD, 1.6% (91 of 5,600) among those with nonobstructive CAD, and 3.8% (142 of 3,742) among those with ≥50% stenosis (p <0.001 among all groups). The annualized incidence of death or MI comparing obstructive to no obstructive CAD among Caucasians was 2.2% versus 0.7% (adjusted hazard ratio [aHR] 2.77, 95% confidence interval [CI] 1.73 to 4.43, p <0.001), among Africans 4.8% versus 1.1% (aHR 6.25, 95% CI 1.12 to 34.97, p = 0.037), and among East Asians 0.8% versus 0.1% (aHR 4.84, 95% CI 2.24 to 10.9, p <0.001). Compared to other ethnicities, East Asians had fewer than expected events (aHR 0.25, 95% CI 0.16 to 0.38, p <0.001). In conclusion, the presence and severity of CAD visualized by CCTA predict death or MI across 3 large ethnicities, whereas normal results on CCTA identify patients at very low risk.
研究表明，冠状动脉计算机断层扫描血管造影（CCTA）检查显示，与冠状动脉疾病（CAD）严重程度相关的死亡率增加，但仅限于相对非多样化的种族人群。本研究旨在评估无先前 CAD 病史的患者中 CAD 对 CCTA 的预后意义，这些患者来自于 2005 年至 2010 年间在 11 个地点（7 个国家）进行的 64 层 CCTA 的前瞻性国际 CCTA 注册中心。CAD 定义为任何冠状动脉粥样硬化，阻塞性 CAD 定义为≥50%狭窄。通过使用 Kaplan-Meier 和 Cox 比例风险，根据种族评估所有原因死亡率和非致死性心肌梗死（MI），并控制基线风险因素、药物和血运重建。共有 16451 名平均年龄为 58 岁（55%为男性）的患者在中位数为 2.0 年（四分位距为 1.4 至 3.2）的时间内接受了随访。患者中 60.1%为白种人，34.4%为东亚人，5.5%为非洲人。无 CAD 患者中 0.5%（38/7109）发生死亡或 MI，非阻塞性 CAD 患者中 1.6%（91/5600），≥50%狭窄患者中 3.8%（142/3742）（所有组之间比较差异均具有统计学意义）。与无阻塞性 CAD 相比，白种人中阻塞性 CAD 患者的死亡或 MI 年发生率为 2.2%对 0.7%（校正后的危险比 [aHR] 2.77，95%置信区间 [CI] 1.73 至 4.43，p<0.001），非洲人为 4.8%对 1.1%（aHR 6.25，95%CI 1.12 至 34.97，p=0.037），东亚人为 0.8%对 0.1%（aHR 4.84，95%CI 2.24 至 10.9，p<0.001）。与其他种族相比，东亚人的事件发生率低于预期（aHR 0.25，95%CI 0.16 至 0.38，p<0.001）。总之，CCTA 显示的 CAD 的存在和严重程度可以预测 3 个主要种族的死亡或 MI，而 CCTA 的正常结果可以识别出低危患者。
