Cardiology Research Office, Ward 16, Ulster Hospital, South Eastern Health and Social, Care Trust, Upper Newtownards Road, Dundonald, Belfast, BT16 1RH, Northern Ireland, UK,
Int J Cardiovasc Imaging. 2013 Oct;29(7):1547-55. doi: 10.1007/s10554-013-0226-6. Epub 2013 Jun 4.
To determine if calcium scores (CS) could act as a more effective gatekeeper than Diamond Forrester (DF) in the assessment of patients with suspected coronary artery disease (CAD). A sub-study of the Cardiac CT for the Assessment of Chest Pain and Plaque (CAPP) study, a randomised control trial evaluating the cost-effectiveness of cardiac CT in symptomatic patients with stable chest pain. Stable pain was defined as troponin negative pain without symptoms of unstable angina. 250 patients undergoing cardiac CT had both DF scores and CS calculated, with the accuracy of both evaluated against CT coronary angiogram. Criteria given in UK national guidelines were compared. Of the 250 patients, 4 withdrew. 140 (57 %) patients were male. The mean DF was 47.8 and mean CS 172.5. Of the 144 patients with non-anginal pain 19.4 % had significant disease (>50 % stenosis). In general the DF over estimated the presence of CAD whereas the CS reclassified patients to lower risk groups, with 91 in the high risk DF category compared to 26 in the CS. Both receiver operating curve and McNemar Bowker test analysis suggested the DF was less accurate in the prediction of CAD compared to CS [Formula: see text] Projected downstream investigations were also calculated, with the cost per number of significant stenoses identified cheaper with the CS criteria. Patients with suspected stable CAD are more accurately risk stratified by CS compared to the traditional DF. CS was more successful in the prediction of significant stenosis and appears to be more effective at targeting clinical resources to those patients that are in need of them.
为了确定钙评分（CS）是否可以比 Diamond Forrester（DF）在疑似冠心病（CAD）患者的评估中更有效地充当守门员。这是一项心脏 CT 评估胸痛和斑块（CAPP）研究的子研究，该研究是一项随机对照试验，评估了心脏 CT 在有稳定胸痛症状的患者中的成本效益。稳定的疼痛被定义为肌钙蛋白阴性疼痛且没有不稳定型心绞痛的症状。250 名接受心脏 CT 检查的患者均计算了 DF 评分和 CS，评估了两者与 CT 冠状动脉造影的准确性。比较了英国国家指南中的标准。在 250 名患者中，有 4 名退出。140 名（57%）患者为男性。平均 DF 为 47.8，平均 CS 为 172.5。在 144 名非心绞痛疼痛患者中，19.4%有严重疾病（>50%狭窄）。一般来说，DF 高估了 CAD 的存在，而 CS 将患者重新分类到较低的风险组，DF 高危组有 91 名，CS 高危组有 26 名。受试者工作特征曲线和 McNemar Bowker 检验分析均表明，DF 在 CAD 预测方面的准确性低于 CS [公式：见正文]还计算了下游的预测性检查，CS 标准确定的有意义狭窄数量的成本效益更高。与传统的 DF 相比，CS 能更准确地对疑似稳定型 CAD 患者进行风险分层。CS 在预测显著狭窄方面更为成功，并且似乎更有效地将临床资源针对那些需要的患者。
