有症状的非阻塞性冠状动脉疾病患者中钙化斑块的预后意义。
Prognostic significance of calcified plaque among symptomatic patients with nonobstructive coronary artery disease.
作者信息
Shah Sana, Bellam Naveen, Leipsic Jonathon, Berman Daniel S, Quyyumi Arshed, Hausleiter Jörg, Achenbach Stephan, Al-Mallah Mouaz, Budoff Matthew J, Cademartiri Fillippo, Callister Tracy Q, Chang Hyuk-Jae, Chow Benjamin J W, Cury Ricardo C, Delago Augustin J, Dunning Allison L, Feuchtner Gudrun M, Hadamitzky Martin, Karlsberg Ronald P, Kaufmann Philipp A, Lin Fay Y, Chinnaiyan Kavitha M, Maffei Erica, Raff Gilbert L, Villines Todd C, Gomez Millie J, Min James K, Shaw Leslee J
机构信息
Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road NE, Room 529, Atlanta, GA, USA.
出版信息
J Nucl Cardiol. 2014 Jun;21(3):453-66. doi: 10.1007/s12350-014-9865-9. Epub 2014 Mar 29.
BACKGROUND
Coronary artery calcium (CAC) is a well-established predictor of clinical outcomes for population screening. Limited evidence is available as to its predictive value in symptomatic patients without obstructive coronary artery disease (CAD). The aim of the current study was to assess the prognostic value of CAC scores among symptomatic patients with nonobstructive CAD.
METHODS
From the COronary Computed Tomographic Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, 7,200 symptomatic patients with nonobstructive CAD (<50% coronary stenosis) on coronary-computed tomographic angiography were prospectively enrolled and followed for a median of 2.1 years. Patients were categorized as without (0% stenosis) or with (>0% but <50% coronary stenosis) a luminal stenosis. CAC scores were calculated using the Agatston method. Univariable and multivariable Cox proportional hazard models were employed to estimate all-cause mortality and/or myocardial infarction (MI). Four-year death and death or MI rates were 1.9% and 3.3%.
RESULTS
Of the 4,380 patients with no luminal stenosis, 86% had CAC scores of <10 while those with a luminal stenosis had more prevalent and extensive CAC with 31.9% having a CAC score of ≥100. Among patients with no luminal stenosis, CAC was not predictive of all-cause mortality (P = .44). However, among patients with a luminal stenosis, 4-year mortality rates ranged from 0.8% to 9.8% for CAC scores of 0 to ≥400 (P < .0001). The mortality hazard was 6.0 (P = .004) and 13.3 (P < .0001) for patients with a CAC score of 100-399 and ≥400. In patients with a luminal stenosis, CAC remained independently predictive in all-cause mortality (P < .0001) and death or MI (P < .0001) in multivariable models containing CAD risk factors and presenting symptoms.
CONCLUSIONS
CAC allows for the identification of those at an increased hazard for death or MI in symptomatic patients with nonobstructive disease. From the CONFIRM registry, the extent of CAC was an independent estimator of long-term prognosis among symptomatic patients with luminal stenosis and may further define risk and guide preventive strategies in patients with nonobstructive CAD.
背景
冠状动脉钙化（CAC）是用于人群筛查临床结局的一项公认预测指标。关于其在无阻塞性冠状动脉疾病（CAD）的有症状患者中的预测价值，现有证据有限。本研究的目的是评估无阻塞性CAD的有症状患者中CAC评分的预后价值。
方法
从冠状动脉计算机断层血管造影临床结局评估：一项国际多中心（CONFIRM）注册研究中，前瞻性纳入7200例冠状动脉计算机断层血管造影显示无阻塞性CAD（冠状动脉狭窄<50%）的有症状患者，并随访中位时间2.1年。患者被分类为无管腔狭窄（0%狭窄）或有管腔狭窄（>0%但<50%冠状动脉狭窄）。使用阿加斯顿方法计算CAC评分。采用单变量和多变量Cox比例风险模型来估计全因死亡率和/或心肌梗死（MI）。4年死亡率和死亡或MI发生率分别为1.9%和3.3%。
结果
在4380例无管腔狭窄的患者中，86%的CAC评分为<10，而有管腔狭窄的患者中CAC更普遍且更广泛，31.9%的患者CAC评分为≥100。在无管腔狭窄的患者中，CAC不能预测全因死亡率（P = 0.44）。然而，在有管腔狭窄的患者中，CAC评分为0至≥400时，4年死亡率范围为0.8%至9.8%（P < 0.0001）。CAC评分为100 - 399和≥400的患者死亡风险分别为6.0（P = 0.004）和13.3（P < 0.0001）。在有管腔狭窄的患者中，在包含CAD危险因素和当前症状的多变量模型中，CAC在全因死亡率（P < 0.0001）和死亡或MI（P < 0.0001）方面仍具有独立预测性。
结论
CAC有助于识别无阻塞性疾病的有症状患者中死亡或MI风险增加的人群。从CONFIRM注册研究来看，CAC的程度是有管腔狭窄的有症状患者长期预后的独立预测指标，并且可能进一步明确无阻塞性CAD患者的风险并指导预防策略。
Zotero 插件