Dedic Admir, Ten Kate Gert-Jan R, Roos Cornelis J, Neefjes Lisan A, de Graaf Michiel A, Spronk Angela, Delgado Victoria, van Lennep Jeanine E Roeters, Moelker Adriaan, Ouhlous Mohamed, Scholte Arthur J H A, Boersma Eric, Sijbrands Eric J G, Nieman Koen, Bax Jeroen J, de Feijter Pim J
Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
Am J Cardiol. 2016 Mar 1;117(5):768-74. doi: 10.1016/j.amjcard.2015.11.058. Epub 2015 Dec 14.
At present, traditional risk factors are used to guide cardiovascular management of asymptomatic subjects. Intensified surveillance may be warranted in those identified as high risk of developing cardiovascular disease (CVD). This study aims to determine the prognostic value of coronary computed tomography (CT) angiography (CCTA) next to the coronary artery calcium score (CACS) in patients at high CVD risk without symptoms suspect for coronary artery disease (CAD). A total of 665 patients at high risk (mean age 56 ± 9 years, 417 men), having at least one important CVD risk factor (diabetes mellitus, familial hypercholesterolemia, peripheral artery disease, or severe hypertension) or a calculated European systematic coronary risk evaluation of >10% were included from outpatient clinics at 2 academic centers. Follow-up was performed for the occurrence of adverse events including all-cause mortality, nonfatal myocardial infarction, unstable angina, or coronary revascularization. During a median follow-up of 3.0 (interquartile range 1.3 to 4.1) years, adverse events occurred in 40 subjects (6.0%). By multivariate analysis, adjusted for age, gender, and CACS, obstructive CAD on CCTA (≥50% luminal stenosis) was a significant predictor of adverse events (hazard ratio 5.9 [CI 1.3 to 26.1]). Addition of CCTA to age, gender, plus CACS, increased the C statistic from 0.81 to 0.84 and resulted in a total net reclassification index of 0.19 (p <0.01). In conclusion, CCTA has incremental prognostic value and risk reclassification benefit beyond CACS in patients without CAD symptoms but with high risk of developing CVD.
目前，传统风险因素用于指导无症状人群的心血管管理。对于那些被确定为心血管疾病（CVD）高风险的人群，强化监测可能是必要的。本研究旨在确定在无症状且无冠心病（CAD）可疑症状但CVD风险高的患者中，冠状动脉计算机断层扫描（CT）血管造影（CCTA）相对于冠状动脉钙化积分（CACS）的预后价值。来自2个学术中心门诊的665例高风险患者（平均年龄56±9岁，417例男性）被纳入研究，这些患者至少有一项重要的CVD风险因素（糖尿病、家族性高胆固醇血症、外周动脉疾病或重度高血压）或计算得出的欧洲系统性冠状动脉风险评估>10%。对不良事件的发生情况进行随访，包括全因死亡率、非致命性心肌梗死、不稳定型心绞痛或冠状动脉血运重建。在中位随访3.0（四分位间距1.3至4.1）年期间，40例受试者（6.0%）发生了不良事件。通过多变量分析，校正年龄、性别和CACS后，CCTA显示的阻塞性CAD（管腔狭窄≥50%）是不良事件的显著预测因素（风险比5.9 [可信区间1.3至26.1]）。将CCTA添加到年龄、性别和CACS中，C统计量从0.81增加到0.84，总净重新分类指数为0.19（p<0.01）。总之，在无CAD症状但有CVD高风险的患者中，CCTA除CACS外具有增量预后价值和风险重新分类益处。
