冠状动脉计算机断层扫描血管造影术上全球斑块负荷的年龄和性别特异性列线图对主要心脏事件的预测价值。
Predictive Value of Age- and Sex-Specific Nomograms of Global Plaque Burden on Coronary Computed Tomography Angiography for Major Cardiac Events.
作者信息
Naoum Christopher, Berman Daniel S, Ahmadi Amir, Blanke Philipp, Gransar Heidi, Narula Jagat, Shaw Leslee J, Kritharides Leonard, Achenbach Stephan, Al-Mallah Mouaz H, Andreini Daniele, Budoff Matthew J, Cademartiri Filippo, Callister Tracy Q, Chang Hyuk-Jae, Chinnaiyan Kavitha, Chow Benjamin, Cury Ricardo C, DeLago Augustin, Dunning Allison, Feuchtner Gudrun, Hadamitzky Martin, Hausleiter Joerg, Kaufmann Philipp A, Kim Yong-Jin, Maffei Erica, Marquez Hugo, Pontone Gianluca, Raff Gilbert, Rubinshtein Ronen, Villines Todd C, Min James, Leipsic Jonathon
机构信息
From the Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (C.N., P.B., J.L.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., H.G.); Department of Cardiology, Mount Sinai Hospital Medical Centre, New York, NY (A.A., J.N.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Cardiology, Concord Hospital and The University of Sydney, New South Wales, Australia (L.K.); Department of Medicine, University of Erlangen, Germany (S.A.); Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI (M.H.A.-M.); Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy (D.A., G.P.); Department of Medicine, Harbor University of California Los Angeles Medical Center (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Duke Clinical Research Institute, Durham, NC (A.D.); Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany (M.H., J.H.); Department of Nuclear Medicine, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, South Korea (Y.-J.K.); Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal (H.M.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, (R.R.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York (J.M.).
出版信息
Circ Cardiovasc Imaging. 2017 Mar;10(3). doi: 10.1161/CIRCIMAGING.116.004896.
BACKGROUND
Age-adjusted coronary artery disease (CAD) burden identified on coronary computed tomography angiography predicts major adverse cardiovascular event (MACE) risk; however, it seldom contributes to clinical decision making because of a lack of nomographic data. We aimed to develop clinically pragmatic age- and sex-specific nomograms of CAD burden using coronary computed tomography angiography and to validate their prognostic use.
METHODS AND RESULTS
Patients prospectively enrolled in phase I of the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes) were included (derivation cohort: n=21,132; 46% female) to develop CAD nomograms based on age-sex percentiles of segment involvement score (SIS) at each year of life (40-79 years). The relationship between SIS age-sex percentiles (SIS%) and MACE (all-cause death, myocardial infarction, unstable angina, and late revascularization) was tested in a nonoverlapping validation cohort (phase II, CONFIRM registry; n=3030, 44% female) by stratifying patients into 3 SIS% groups (≤50th, 51-75th, and >75th) and comparing annualized MACE rates and time to MACE using multivariable Cox proportional hazards models adjusting for Framingham risk and chest pain typicality. Age-sex percentiles were well fitted to second-order polynomial curves (men: =0.86±0.12; women: =0.86±0.14). Using the nomograms, there were 1576, 965, and 489 patients, respectively, in the ≤50th, 51-75th, and >75th SIS% groups. Annualized event rates were higher among patients with greater CAD burden (2.1% [95% confidence interval: 1.7%-2.7%], 3.9% [95% confidence interval: 3.0%-5.1%], and 7.2% [95% confidence interval: 5.4%-9.6%] in ≤50th, 51-75th, and >75th SIS% groups, respectively; <0.001). Adjusted MACE risk was significantly increased among patients in SIS% groups above the median compared with patients below the median (hazard ratio [95% confidence interval]: 1.9 [1.3-2.8] for 51-75th SIS% group and 3.4 [2.3-5.0] for >75th SIS% group; <0.01 for both).
CONCLUSIONS
We have developed clinically pragmatic age- and sex-specific nomograms of CAD prevalence using coronary computed tomography angiography findings. Global plaque burden measured using SIS% is predictive of cardiac events independent of traditional risk assessment.
CLINICAL TRIAL REGISTRATION
URL: https://www.clinicaltrials.gov. Unique identifier: NCT01443637.
背景
经冠状动脉计算机断层扫描血管造影术确定的年龄校正后的冠状动脉疾病（CAD）负担可预测主要不良心血管事件（MACE）风险；然而，由于缺乏列线图数据，它很少有助于临床决策。我们旨在利用冠状动脉计算机断层扫描血管造影术开发临床上实用的CAD负担年龄和性别特异性列线图，并验证其预后用途。
方法和结果
纳入前瞻性参加CONFIRM注册研究（冠状动脉CT血管造影临床结果评估）第一阶段的患者（推导队列：n = 21132；46%为女性），以根据每年（40 - 79岁）各年龄段的节段受累评分（SIS）的年龄 - 性别百分位数来制定CAD列线图。在一个非重叠验证队列（CONFIRM注册研究第二阶段；n = 3030，44%为女性）中，通过将患者分为3个SIS%组（≤第50百分位数、第51 - 75百分位数和>第75百分位数），并使用调整了弗雷明汉风险和胸痛典型性的多变量Cox比例风险模型比较年化MACE发生率和发生MACE的时间，来检验SIS年龄 - 性别百分位数（SIS%）与MACE（全因死亡、心肌梗死、不稳定型心绞痛和晚期血运重建）之间的关系。年龄 - 性别百分位数与二阶多项式曲线拟合良好（男性： = 0.86 ± 0.12；女性： = 0.86 ± 0.14）。使用列线图时，SIS%≤第50百分位数、第51 - 75百分位数和>第75百分位数组分别有1576、965和489例患者。CAD负担较重的患者年化事件发生率较高（SIS%≤第50百分位数、第51 - 75百分位数和>第75百分位数组分别为2.1%[95%置信区间：1.7% - 2.7%]、3.9%[95%置信区间：3.0% - 5.1%]和7.2%[95%置信区间：5.4% - 9.6%]；<0.001）。与中位数以下的患者相比，中位数以上SIS%组患者的校正MACE风险显著增加（第51 - 75百分位数SIS%组的风险比[95%置信区间]：1.9[1.3 - 2.8]，>第75百分位数SIS%组为3.4[2.3 - 5.0]；两者均<0.01）。
结论
我们利用冠状动脉计算机断层扫描血管造影术的结果开发了临床上实用的CAD患病率年龄和性别特异性列线图。使用SIS%测量的总体斑块负担可独立于传统风险评估预测心脏事件。
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