Nakanishi Rine, Li Dong, Blaha Michael J, Whelton Seamus P, Darabian Sirous, Flores Ferdinand R, Dailing Christopher, Blumenthal Roger S, Nasir Khurram, Berman Daniel S, Budoff Matthew J
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
Eur Heart J Cardiovasc Imaging. 2016 Nov;17(11):1305-1314. doi: 10.1093/ehjci/jev328. Epub 2015 Dec 24.
Although coronary artery calcium (CAC) has been established as a robust tool for predicting total mortality during intermediate follow-up, less is known about the long-term predictive value of CAC.
This study included 13 092 asymptomatic patients without known cardiovascular disease who underwent a clinically indicated CAC scan. CAC was categorized as an Agatson score of 0, 1-99, 100-399, and ≥400. We used multivariable Cox proportional hazards to calculate adjusted hazard ratios (HRs) for mortality stratified by age (younger, intermediate, or older) and gender. The mean age of participants was 58 ± 11 years and 67% were men. During a median follow-up of 11.0 ± 3.2 years, there were 522 deaths (4.0%). Compared with CAC = 0, increasing CAC was associated with higher mortality rate: 1-99 [HR: 1.5, 95% confidence interval (95% CI): 1.1-2.1]; 100-399 (HR: 1.8, 95% CI: 1.3-2.5); ≥400 (HR: 2.6, 95% CI: 1.9-3.6). Relative risk according to CAC category did not differ between genders. The strongest associations between CAC and mortality were observed for young and intermediate age participants. Nonetheless, the mortality rate of the older patients with CAC = 0 was far lower than that of the general US population. CAC was more predictive of long-term (15 years) than intermediate-term (5 years) mortality for men [receiver operator characteristics (ROC): 0.723 vs. 0.702] and women (ROC: 0.69 vs. 0.65).
CAC is strongly associated with the long-term risk of mortality in young- and middle-aged men and women. In older patients, the long-term risk stratification of CAC is lower, due principally to increased mortality rate in patients with low calcium scores; however, even in the older patients, those with absent or low CAC are at a significantly lower risk of mortality compared with the general population.
虽然冠状动脉钙化（CAC）已被确立为预测中期随访期间总死亡率的有力工具，但关于CAC的长期预测价值知之甚少。
本研究纳入了13092例无已知心血管疾病的无症状患者，他们接受了临床指征的CAC扫描。CAC被分类为阿加特森评分0、1 - 99、100 - 399和≥400。我们使用多变量Cox比例风险模型计算按年龄（年轻、中年或老年）和性别分层的死亡率调整风险比（HRs）。参与者的平均年龄为58±11岁，67%为男性。在中位随访11.0±3.2年期间,有522例死亡（4.0%）。与CAC = 0相比，CAC增加与更高的死亡率相关：1 - 99 [HR：1.5，95%置信区间（95%CI）：1.1 - 2.1]；100 - 399（HR：1.8，95%CI：1.3 - 2.5）；≥400（HR：2.6，95%CI：1.9 - 3.6）。根据CAC类别划分的相对风险在性别之间没有差异。在年轻和中年参与者中观察到CAC与死亡率之间最强的关联。尽管如此，CAC = 0的老年患者的死亡率远低于美国普通人群。对于男性[受试者操作特征（ROC）：0.723对vs. 0.702]和女性（ROC：0.69对vs. 0.65），CAC对长期（15年）死亡率的预测比对中期（5年）死亡率的预测更强。
CAC与年轻和中年男性及女性的长期死亡风险密切相关。在老年患者中，CAC的长期风险分层较低，主要是由于低钙评分患者的死亡率增加；然而，即使在老年患者中，与普通人群相比，CAC缺失或低的患者死亡风险也显著较低。
