Shreibati Jacqueline Baras, Baker Laurence C, McConnell Michael V, Hlatky Mark A
From the Stanford University School of Medicine, Stanford, CA (J.B.S., L.C.B., M.V.M., M.A.H.); and National Bureau of Economic Research, Cambridge, MA (L.C.B.).
Circ Cardiovasc Imaging. 2014 Jul;7(4):655-62. doi: 10.1161/CIRCIMAGING.113.001869. Epub 2014 Apr 28.
Biomarkers improve cardiovascular disease (CVD) risk prediction, but their comparative effectiveness in clinical practice is not known. We sought to compare the use, spending, and clinical outcomes in asymptomatic Medicare beneficiaries evaluated for CVD with coronary artery calcium (CAC) or other cardiovascular risk markers.
We used a 20% sample of 2005 to 2011 Medicare claims to identify fee-for-service beneficiaries aged ≥65.5 years with no CVD claims in the previous 6 months. We matched patients with CAC with patients who received high-sensitivity C-reactive protein (hs-CRP; n=8358) or lipid screening (n=6250) using propensity-score methods. CAC was associated with increased noninvasive cardiac testing within 180 days (hazard ratio, 2.22, 95% confidence interval, 1.68-2.93, P<0.001, versus hs-CRP; hazard ratio, 4.30, 95% confidence interval, 3.04-6.06, P<0.001, versus lipid screening) and increased coronary angiography and revascularization. During 3-year follow-up, CAC was associated with higher CVD-related spending ($6525 versus $4432 for hs-CRP, P<0.001; and $6500 versus $3073 for lipid screening, P<0.001) and fewer CVD-related events when compared with hs-CRP (hazard ratio, 0.74, 95% confidence interval, 0.58-0.94, P=0.017) but not compared with lipid screening (hazard ratio, 0.84, 95% confidence interval, 0.64-1.11, P=0.23).
CAC testing among asymptomatic Medicare beneficiaries was associated with increased use of cardiac tests and procedures, higher spending, and slightly improved clinical outcomes when compared with hs-CRP testing.
生物标志物可改善心血管疾病（CVD）风险预测，但它们在临床实践中的相对有效性尚不清楚。我们试图比较在对无症状医疗保险受益人进行心血管疾病评估时，使用冠状动脉钙化（CAC）或其他心血管风险标志物的情况、花费及临床结局。
我们使用2005年至2011年医疗保险理赔数据的20%样本，来识别年龄≥65.5岁、在过去6个月内无心血管疾病理赔记录的按服务收费受益人。我们使用倾向评分法将接受CAC检测的患者与接受高敏C反应蛋白（hs-CRP；n = 8358）检测或血脂筛查（n = 6250）的患者进行匹配。与hs-CRP相比，CAC与180天内无创心脏检查增加相关（风险比，2.22；95%置信区间，1.68 - 2.93；P < 0.001），与血脂筛查相比亦如此（风险比，4.30；95%置信区间，3.04 - 6.06；P < 0.001），同时冠状动脉造影和血运重建也增加。在3年随访期间，与hs-CRP相比，CAC与更高的心血管疾病相关花费有关（分别为6525美元和4432美元，P < 0.001；与血脂筛查相比分别为6500美元和3073美元，P < 0.001），且心血管疾病相关事件较少（风险比，0.74；95%置信区间，0.58 - 0.94；P = 0.017），但与血脂筛查相比无差异（风险比，0.84；95%置信区间，0.64 - 1.11；P = 0.23）。
与hs-CRP检测相比，无症状医疗保险受益人中的CAC检测与心脏检查和手术的使用增加、花费更高以及临床结局略有改善相关。
