University of Munich, Department of Cardiology, Campus Grosshadern, Munich, Germany.
University of Munich, Department of Cardiology, Campus Grosshadern, Munich, Germany.
Am Heart J. 2014 Apr;167(4):568-75. doi: 10.1016/j.ahj.2013.12.011. Epub 2014 Jan 3.
Coronary calcifications are a marker of coronary atherosclerosis. The role of coronary calcium scoring (CS) as part of the initial evaluation of patients with suspected coronary heart disease (CHD) is controversially discussed. The primary goal of this study was to characterize the coronary calcium distribution in this particular patient population. In a second step, we aimed to establish a possible clinical implication using CS for the diagnosis of CHD.
Calcium scoring procedure was performed by either using a multidetector or a dual-source computed tomographic scanner. All patients underwent invasive coronary angiography (ICA) as the current criterion standard for CHD detection. A total of 4,137 (2,780 men, mean age 60.5 ± 12.4 years) consecutive patients were included.
Mean CS was 288 ± 446 (range 0-5,252). Overall coronary artery calcifications significantly increased with patients' age. In 2,048 patients (mean CS 101 ± 239, range 0-5252), significant CHD (≥50% stenosis) was excluded by ICA (1,939 patients without calcifications). In remaining 2,089 patients (51%, mean CS 607 ± 821, range 0-5,252), significant CHD was documented leading to intervention in 732 patients. A threshold of zero calcifications (existence of calcified tissue) had the best overall sensitivity and negative predictive value with 99%. Overall specificity with 34% and overall positive predictive value with 24% were rather low.
Coronary calcium scoring is able to exclude significant CHD in patients with suspected CHD with a high negative predictive value and, therefore, possibly reduce the number of invasive diagnostic examinations. Because of the low specificity and positive predictive value, CS cannot be used to indicate ICA.
冠状动脉钙化是冠状动脉粥样硬化的一个标志物。冠状动脉钙评分（CS）作为疑似冠心病（CHD）患者初始评估的一部分，其作用存在争议。本研究的主要目的是描述该特定患者人群的冠状动脉钙分布情况。在第二步中，我们旨在通过 CS 对 CHD 的诊断建立可能的临床意义。
使用多排或双源计算机断层扫描（CT）扫描仪进行钙评分。所有患者均接受经皮冠状动脉造影（ICA）检查，ICA 是目前 CHD 检测的金标准。共纳入 4137 例（男 2780 例，平均年龄 60.5±12.4 岁）连续患者。
平均 CS 为 288±446（范围 0-5252）。总的冠状动脉钙化随着患者年龄的增长而显著增加。在 2048 例患者（平均 CS 为 101±239，范围 0-5252）中，ICA 排除了明显的 CHD（≥50%狭窄）（1939 例无钙化患者）。在剩余的 2089 例患者（51%，平均 CS 为 607±821，范围 0-5252）中，记录到明显的 CHD，并对 732 例患者进行了介入治疗。存在钙化组织的零钙化（即钙化组织的存在）具有最佳的总体敏感性和阴性预测值，分别为 99%和 99%。总体特异性为 34%，总体阳性预测值为 24%，均较低。
在疑似 CHD 的患者中，CS 能够通过高阴性预测值排除明显的 CHD，因此可能减少有创诊断检查的数量。由于特异性和阳性预测值较低，CS 不能用于指示 ICA。
