Arnson Yoav, Rozanski Alan, Gransar Heidi, Friedman John D, Hayes Sean W, Thomson Louise E, Tamarappoo Balaji, Slomka Piotr, Wang Frances, Germano Guido, Dey Damini, Berman Daniel S
Department of Imaging, Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute, Los Angeles, California; Division of Cardiology, Mt Sinai St. Luke's Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Imaging, Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute, Los Angeles, California; Division of Cardiology, Mt Sinai St. Luke's Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, New York.
Am J Cardiol. 2017 Dec 15;120(12):2154-2159. doi: 10.1016/j.amjcard.2017.09.001. Epub 2017 Sep 18.
Multiple coronary artery calcium (CAC) parameters have recently been proposed to improve risk prediction in patients with intermediate clinical risk based on CAC scoring, but outcome data that assess these variables are relatively sparse. We analyzed data from 11,633 consecutive asymptomatic patients undergoing CAC scanning that were followed for 8.8 ± 3.5 years for all-cause mortality (ACM). The patients who had coronary artery calcification were grouped by the number of calcified coronary plaques: 0, 1 to 5, 6 to 20, and >20 plaques. We examined the independent prognostic value of plaque number and its synergistic prognostic value when added to the CAC score. We observed a stepwise increase in ACM with increasing plaque number. In patients with a CAC score of 1 to 99, 6 plaques or more were associated with increased mortality. In patients with CAC scores of 100 to 399, there was a stepwise increase in ACM with increasing plaque number. For CAC >400, the risk of ACM was high regardless of plaque number. After risk adjustment, the number of plaques was a significant predictor of risk for ACM in the patients with an intermediate CAC score. In these patients, additional consideration of plaque number improved net reclassification improvement for predicting ACM by 29%. In conclusion, the number of calcified plaques adds to risk stratification beyond the CAC score in patients with intermediate CAC scores.
最近有人提出多种冠状动脉钙化（CAC）参数，以改善基于CAC评分的中度临床风险患者的风险预测，但评估这些变量的结局数据相对较少。我们分析了11633例连续接受CAC扫描的无症状患者的数据，对其进行了8.8±3.5年的全因死亡率（ACM）随访。将有冠状动脉钙化的患者按钙化冠状动脉斑块数量分组：0个、1至5个、6至20个和>20个斑块。我们研究了斑块数量的独立预后价值及其加入CAC评分后的协同预后价值。我们观察到随着斑块数量增加，ACM呈逐步上升趋势。在CAC评分为1至99的患者中，6个或更多斑块与死亡率增加相关。在CAC评分为100至399的患者中，随着斑块数量增加，ACM呈逐步上升趋势。对于CAC>400的患者，无论斑块数量多少，ACM风险都很高。经过风险调整后，斑块数量是中度CAC评分患者ACM风险的重要预测因素。在这些患者中，额外考虑斑块数量可使预测ACM的净重新分类改善提高29%。总之，在中度CAC评分患者中，钙化斑块数量在CAC评分之外增加了风险分层。
