Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, 72205, USA.
Division of Cardiology, Ain Shams University, Cairo, Egypt.
Curr Cardiol Rep. 2018 Feb 12;20(2):10. doi: 10.1007/s11886-018-0951-5.
This review aims to summarize the evidence and challenges of coronary artery calcium (CAC) scoring as a screening tool for coronary artery disease (CAD) in young adults.
Several cohort studies have highlighted the value of CAC scoring in CAD risk assessment in young adults. The largest study to date is the Coronary Artery Risk Development in Young Adults (CARDIA) study. The study examined patients at 18-30 years of age and demonstrated that the presence of any degree of CAC was associated with a higher risk of coronary events compared to zero CAC, with an incremental increase in the risk of events with higher scores. However, it is important to note that 70% of patients screened had CAC = 0 at the age of 56. Despite the evidence that higher CAC score cutoff used in guidelines for predicting cardiovascular risk may be "falsely reassuring," however, mass screening of young adults using CAC score may be challenging. The development of prediction tools and scoring systems to identify patients at higher risk of developing CAC based on known CAD risk factors may help reduce the number needed to screen to detect patients with positive CAC.
本文旨在总结冠状动脉钙（CAC）评分作为年轻患者冠状动脉疾病（CAD）筛查工具的证据和挑战。
多项队列研究强调了 CAC 评分在年轻患者 CAD 风险评估中的价值。迄今为止最大的研究是冠状动脉风险发展在年轻人（CARDIA）研究。该研究检查了 18-30 岁的患者，结果表明，与无 CAC 相比，任何程度的 CAC 均与更高的冠状动脉事件风险相关，且 CAC 评分越高，事件风险呈递增趋势。然而，需要注意的是，在 56 岁时，70%的筛查患者的 CAC=0。尽管存在证据表明，指南中用于预测心血管风险的更高 CAC 评分切点可能“错误地令人安心”，但是，使用 CAC 评分对年轻患者进行大规模筛查可能具有挑战性。开发预测工具和评分系统，基于已知的 CAD 危险因素来识别 CAC 风险较高的患者，可能有助于减少筛查阳性 CAC 患者所需的人数。
