Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, 60 Murray Street, Suite L5-025, Mailbox-21, Toronto, ON, Canada M5T 3L9.
BMJ. 2013 Mar 25;346:f1654. doi: 10.1136/bmj.f1654.
To investigate the association of coronary artery calcium score with all cause mortality and cardiovascular events in people with type 2 diabetes.
Systematic review and meta-analysis of observational studies.
Studies were identified from Embase, PubMed, and abstracts from the 2011 and 2012 annual meetings of the American Diabetes Association, European Association for the Study of Diabetes, American College of Cardiology, and American Heart Association (2011).
Prospective studies that evaluated baseline coronary artery calcium score in people with type 2 diabetes and subsequent all cause mortality or cardiovascular events (fatal and non-fatal).
Two independent reviewers extracted the data. The predictive value of the coronary artery calcium score was assessed by random effects model.
Eight studies were included (n=6521; 802 events; mean follow-up 5.18 years). The relative risk for all cause mortality or cardiovascular events, or both comparing a total coronary artery calcium score of ≥ 10 with a score of <10 was 5.47 (95% confidence interval 2.59 to 11.53; I(2)=82.4%, P<0.001). The overall sensitivity of a total coronary artery calcium score of ≥ 10 for this composite outcome was 94% (95% confidence interval 89% to 96%), with a specificity of 34% (24% to 44%). The positive and negative likelihood ratios were 1.41 (95% confidence interval 1.20 to 1.66) and 0.18 (0.10 to 0.30), respectively. For people with a coronary artery calcium score of <10, the post-test probability of the composite outcome was about 1.8%, representing a 6.8-fold reduction from the pretest probability. Four studies evaluated cardiovascular events as the outcome (n=1805; 351 events). The relative risk for cardiovascular events comparing a total coronary artery calcium score of ≥ 10 with a score of <10 was 9.22 (2.73 to 31.07; I(2)=76.7%, P=0.005). The positive and negative likelihood ratios were 1.67 (1.30 to 2.17) and 0.11 (0.04 to 0.29), respectively.
In people with type 2 diabetes, a coronary artery calcium score of ≥ 10 predicts all cause mortality or cardiovascular events, or both, and cardiovascular events alone, with high sensitivity but low specificity. Clinically, the finding of a coronary artery calcium score of <10 may facilitate risk stratification by enabling the identification of people at low risk within this high risk population.
探讨冠状动脉钙评分与 2 型糖尿病患者全因死亡率和心血管事件的关系。
对观察性研究进行系统评价和荟萃分析。
从 Embase、PubMed 和 2011 年和 2012 年美国糖尿病协会、欧洲糖尿病研究协会、美国心脏病学会和美国心脏协会年会上的摘要中检索研究（2011 年）。
前瞻性研究，评估 2 型糖尿病患者的基线冠状动脉钙评分，以及随后的全因死亡率或心血管事件（致死性和非致死性）。
两名独立的审查员提取数据。使用随机效应模型评估冠状动脉钙评分的预测价值。
共纳入 8 项研究（n=6521；802 例事件；平均随访 5.18 年）。与冠状动脉钙评分<10 相比，评分≥10 的全因死亡率或心血管事件或两者的相对风险为 5.47（95%置信区间 2.59 至 11.53；I²=82.4%，P<0.001）。冠状动脉钙评分≥10 对该复合结局的总体敏感性为 94%（95%置信区间 89%至 96%），特异性为 34%（24%至 44%）。阳性和阴性似然比分别为 1.41（95%置信区间 1.20 至 1.66）和 0.18（0.10 至 0.30）。对于冠状动脉钙评分<10 的患者，复合结局的后验概率约为 1.8%，与前验概率相比降低了 6.8 倍。4 项研究将心血管事件作为结局（n=1805；351 例事件）。与冠状动脉钙评分<10 相比，评分≥10 的心血管事件的相对风险为 9.22（2.73 至 31.07；I²=76.7%，P=0.005）。阳性和阴性似然比分别为 1.67（1.30 至 2.17）和 0.11（0.04 至 0.29）。
在 2 型糖尿病患者中，冠状动脉钙评分≥10 预测全因死亡率或心血管事件或两者，并预测心血管事件，具有较高的敏感性和较低的特异性。临床上，冠状动脉钙评分<10 的发现可通过识别高危人群中的低危人群，有助于进行危险分层。
