Chiles Caroline, Duan Fenghai, Gladish Gregory W, Ravenel James G, Baginski Scott G, Snyder Bradley S, DeMello Sarah, Desjardins Stephanie S, Munden Reginald F
From the Department of Radiology, Wake Forest University Health Sciences Center, Medical Center Boulevard, Winston-Salem, NC 27157 (C.C.); Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI (F.D., B.S.S., S.D.); Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.W.G.); Department of Radiology, Medical University of South Carolina, Charleston, SC (J.G.R.); Summit Radiology LLC, Oconomowoc, Wis (S.G.B.); American College of Radiology Imaging Network, Philadelphia, Pa (S.S.D.); and Department of Radiology, Houston Methodist Hospital and Research Institute, Houston, Tex (R.F.M.).
Radiology. 2015 Jul;276(1):82-90. doi: 10.1148/radiol.15142062. Epub 2015 Mar 9.
To evaluate three coronary artery calcification (CAC) scoring methods to assess risk of coronary heart disease (CHD) death and all-cause mortality in National Lung Screening Trial (NLST) participants across levels of CAC scores.
The NLST was approved by the institutional review board at each participating institution, and informed consent was obtained from all participants. Image review was HIPAA compliant. Five cardiothoracic radiologists evaluated 1575 low-dose computed tomographic (CT) scans from three groups: 210 CHD deaths, 315 deaths not from CHD, and 1050 participants who were alive at conclusion of the trial. Radiologists used three scoring methods: overall visual assessment, segmented vessel-specific scoring, and Agatston scoring. Weighted Cox proportional hazards models were fit to evaluate the association between scoring methods and outcomes.
In multivariate analysis of time to CHD death, Agatston scores of 1-100, 101-1000, and greater than 1000 (reference category 0) were associated with hazard ratios of 1.27 (95% confidence interval: 0.69, 2.53), 3.57 (95% confidence interval: 2.14, 7.48), and 6.63 (95% confidence interval: 3.57, 14.97), respectively; hazard ratios for summed segmented vessel-specific scores of 1-5, 6-11, and 12-30 (reference category 0) were 1.72 (95% confidence interval: 1.05, 3.34), 5.11 (95% confidence interval: 2.92, 10.94), and 6.10 (95% confidence interval: 3.19, 14.05), respectively; and hazard ratios for overall visual assessment of mild, moderate, or heavy (reference category none) were 2.09 (95% confidence interval: 1.30, 4.16), 3.86 (95% confidence interval: 2.02, 8.20), and 6.95 (95% confidence interval: 3.73, 15.67), respectively.
By using low-dose CT performed for lung cancer screening in older, heavy smokers, a simple visual assessment of CAC can be generated for risk assessment of CHD death and all-cause mortality, which is comparable to Agatston scoring and strongly associated with outcome.
评估三种冠状动脉钙化（CAC）评分方法，以评估国家肺癌筛查试验（NLST）参与者在不同CAC评分水平下的冠心病（CHD）死亡风险和全因死亡率。
NLST经各参与机构的机构审查委员会批准，并获得所有参与者的知情同意。图像审查符合健康保险流通与责任法案（HIPAA）。五名心胸放射科医生对来自三组的1575例低剂量计算机断层扫描（CT）进行了评估：210例CHD死亡患者、315例非CHD死亡患者以及1050例在试验结束时仍存活的参与者。放射科医生使用了三种评分方法：整体视觉评估、分段血管特异性评分和阿加斯顿评分。采用加权Cox比例风险模型来评估评分方法与结局之间的关联。
在对CHD死亡时间的多变量分析中，阿加斯顿评分为1 - 100、101 - 1000和大于1000（参考类别为0）时，风险比分别为1.27（95%置信区间：0.69，2.53）、3.57（95%置信区间：2.14，7.48）和6.63（95%置信区间：3.57，14.97）；分段血管特异性评分总和为1 - 5、6 - 11和12 - 30（参考类别为0）时，风险比分别为1.72（95%置信区间：1.05，3.34）、5.11（95%置信区间：2.92，10.94）和6.10（95%置信区间：3.19，14.05）；整体视觉评估为轻度、中度或重度（参考类别为无）时，风险比分别为2.09（95%置信区间：1.30，4.16）、3.86（95%置信区间：2.02，8.20）和6.95（95%置信区间：3.73，15.67）。
通过对老年重度吸烟者进行用于肺癌筛查的低剂量CT检查，可以生成简单的CAC视觉评估，用于CHD死亡风险评估和全因死亡率评估，其与阿加斯顿评分相当，且与结局密切相关。
