Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health; Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing 100191, China.
Department of Radiology, Peking University Third Hospital, Beijing 100191, China.
J Geriatr Cardiol. 2014 Jun;11(2):113-9. doi: 10.3969/j.issn.1671-5411.2014.02.006.
To evaluate the prognostic value of the coronary artery calcium (CAC) score in patients with stable angina pectoris (SAP) who underwent percutaneous coronary intervention (PCI).
A total of 334 consecutive patients with SAP who underwent first PCI following multi-slice computer tomography (MSCT) were enrolled from our institution between January 2007 and June 2012. The CAC score was calculated according to the standard Agatston calcium scoring algorithm. Complex PCI was defined as use of high pressure balloon, kissing balloon and/or rotablator. Procedure-related complications included dissection, occlusion, perforation, no/slow flow and emergency coronary artery bypass grafting. Main adverse cardiac events (MACE) were defined as a combined end point of death, non-fatal myocardial infarction, target lesion revascularization and rehospitalization for cardiac ischemic events.
Patients with a CAC score > 300 (n = 145) had significantly higher PCI complexity (13.1% vs. 5.8%, P = 0.017) and rate of procedure-related complications (17.2% vs. 7.4%, P = 0.005) than patients with a CAC score ≤ 300 (n = 189). After a median follow-up of 22.5 months (4-72 months), patients with a CAC score ≤ 300 differ greatly than those patients with CAC score > 300 in cumulative non-events survival rates (88.9 vs. 79.0%, Log rank 4.577, P = 0.032). After adjusted for other factors, the risk of MACE was significantly higher [hazard ratio (HR): 4.3, 95% confidence interval (95% CI): 2.4-8.2, P = 0.038] in patients with a CAC score > 300 compared to patients with a lower CAC score.
The CAC score is an independent predictor for MACE in SAP patients who underwent PCI and indicates complexity of PCI and procedure-related complications.
评估在接受经皮冠状动脉介入治疗（PCI）的稳定型心绞痛（SAP）患者中，冠状动脉钙（CAC）评分的预后价值。
本研究纳入了 2007 年 1 月至 2012 年 6 月期间在我院接受多层螺旋 CT（MSCT）检查后首次接受 PCI 的 334 例 SAP 连续患者。CAC 评分根据标准的 Agatston 钙评分算法计算。复杂 PCI 定义为使用高压球囊、亲吻球囊和/或旋磨术。与操作相关的并发症包括夹层、闭塞、穿孔、无/慢血流和紧急冠状动脉旁路移植术。主要不良心脏事件（MACE）定义为死亡、非致死性心肌梗死、靶病变血运重建和因心脏缺血事件再住院的联合终点。
CAC 评分>300 的患者（n=145）的 PCI 复杂程度（13.1% vs. 5.8%，P=0.017）和操作相关并发症发生率（17.2% vs. 7.4%，P=0.005）明显高于 CAC 评分≤300 的患者（n=189）。中位随访 22.5 个月（4-72 个月）后，CAC 评分≤300 的患者与 CAC 评分>300 的患者在累积无事件生存率方面存在显著差异（88.9% vs. 79.0%，Log rank 4.577，P=0.032）。在调整其他因素后，CAC 评分>300 的患者发生 MACE 的风险显著更高[风险比（HR）：4.3，95%置信区间（95%CI）：2.4-8.2，P=0.038]。
CAC 评分是接受 PCI 的 SAP 患者 MACE 的独立预测因子，提示 PCI 的复杂性和与操作相关的并发症。
