Saint Luke's Mid America Heart Institute, Kansas City; Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City.
Mayo Clin Proc. 2013 Aug;88(8):806-12. doi: 10.1016/j.mayocp.2013.05.019.
To report and compare the outcomes and survival of patients with abnormal computed tomography-derived coronary artery calcium (CT-CAC) scores undergoing aggressive medical treatment at a cardiac prevention clinic.
We conducted a retrospective analysis of 849 patients with intermediate risk based on the Framingham risk score and an abnormal CT-CAC score who were aggressively treated in a preventive cardiology risk factor modification program from June 23, 2000, to September 1, 2012. The primary outcome was a composite end point of myocardial infarction, resuscitated cardiac arrest, revascularization, and cardiovascular death. The effect of the CT-CAC subgroup on major adverse coronary heart disease events (MACEs) was evaluated by calculating hazard ratios with Cox proportional hazards regression modeling. The Centers for Disease Control and Prevention Wonder database was used to identify age- and sex-matched controls from the general population of Kansas and Missouri.
The mean age of the study patients was 65.4 years (58.4% men [496]). The median follow-up was 58 months, and the mean CT-CAC score was 336 Agatston units. Thirty-four patients (4.0%) reached the primary end point, including 4 deaths. The adjusted 10-year mortality rates were similar in the study group and control group (9.3 vs 10.6; P=.80). After adjustment, a CT-CAC score greater than 400 Agatston units correlated with a higher risk of MACEs (hazard ratio, 3.55; P=.01).
These results suggest that intermediate-risk patients with abnormal CT-CAC scores when treated with intensive risk factor reduction have lower rates of MACEs than predicted by the Framingham risk score and the presence of coronary artery calcium.
报告并比较在心脏预防门诊接受强化药物治疗的冠状动脉 CT 钙评分异常患者的结局和存活率。
我们对 2000 年 6 月 23 日至 2012 年 9 月 1 日期间在预防心脏病学危险因素修正计划中接受强化治疗的基于弗雷明汉风险评分和异常 CT-CAC 评分的 849 名中等风险患者进行了回顾性分析。主要终点是心肌梗死、复苏性心脏骤停、血运重建和心血管死亡的复合终点。通过使用 Cox 比例风险回归模型计算风险比来评估 CT-CAC 亚组对主要不良冠状动脉心脏事件（MACEs）的影响。使用疾病预防控制中心 Wonder 数据库从堪萨斯州和密苏里州的一般人群中确定年龄和性别匹配的对照组。
研究患者的平均年龄为 65.4 岁（58.4%为男性[496 人]）。中位随访时间为 58 个月，平均 CT-CAC 评分为 336 个 Agatston 单位。34 名患者（4.0%）达到了主要终点，包括 4 例死亡。研究组和对照组的 10 年调整死亡率相似（9.3%对 10.6%；P=0.80）。调整后，CT-CAC 评分大于 400 Agatston 单位与 MACEs 风险增加相关（风险比，3.55；P=0.01）。
这些结果表明，接受强化危险因素降低治疗的异常 CT-CAC 评分的中等风险患者的 MACEs 发生率低于弗雷明汉风险评分和冠状动脉钙存在所预测的发生率。
