Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL; UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL; UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, AL.
Department of Radiology, University of Michigan, Ann Arbor, MI.
Chest. 2018 Sep;154(3):579-587. doi: 10.1016/j.chest.2018.05.037. Epub 2018 Jun 8.
COPD is associated with cardiovascular disease (CVD), and coronary artery calcification (CAC) provides additional prognostic information. With increasing use of nongated CT scans in clinical practice, this study hypothesized that the visual Weston CAC score would perform as well as the Agatston score in predicting prevalent and incident coronary artery disease (CAD) and CVD in COPD.
CAC was measured by using Agatston and Weston scores on baseline CT scans in 1,875 current and former smokers enrolled in the Genetic Epidemiology of COPD (COPDGene) study. Baseline cardiovascular disease and incident cardiac events on longitudinal follow-up were recorded. Accuracy of the CAC scores was measured by using receiver-operating characteristic analysis, and Cox proportional hazards analyses were used to estimate the risk of incident cardiac events.
CAD was reported by 133 (7.1%) subjects at baseline. A total of 413 (22.0%) and 241 (12.9%) patients had significant CAC according to the Weston (≥ 7) and Agatston (≥ 400) scores, respectively; the two methods were significantly correlated (r = 0.84; P < .001). Over 5 years of follow-up, 127 patients (6.8%) developed incident CVD. For predicting prevalent CAD, c-indices for the Weston and Agatston scores were 0.78 and 0.74 and for predicting incident CVD, they were 0.62 and 0.61. After adjustment for age, race, sex, smoking pack-years, FEV, percent emphysema, and CT scanner type, a Weston score ≥ 7 was associated with time to first acute coronary event (hazard ratio, 2.16 [95% CI, 1.32 to 3.53]; P = .002), but a Agatston score ≥ 400 was not (hazard ratio, 1.75 [95% CI, 0.99-3.09]; P = .053).
A simple visual score for CAC performed well in predicting incident CAD in smokers with and without COPD.
ClinicalTrials.gov; No.: NCT00608764; URL: www.clinicaltrials.gov.
慢性阻塞性肺疾病（COPD）与心血管疾病（CVD）相关，冠状动脉钙化（CAC）可提供额外的预后信息。随着非门控 CT 扫描在临床实践中的广泛应用，本研究假设视觉 Weston CAC 评分与 Agatston 评分在预测 COPD 患者现患和新发冠状动脉疾病（CAD）和 CVD 方面具有相同的效能。
在 Genetic Epidemiology of COPD（COPDGene）研究中，对 1875 名现吸烟者和曾吸烟者的基线 CT 扫描进行 CAC 测量，采用 Agatston 和 Weston 评分进行测量。记录基线心血管疾病和纵向随访中的心脏事件。通过受试者工作特征分析测量 CAC 评分的准确性，并采用 Cox 比例风险分析估计心脏事件的风险。
133 名（7.1%）受试者在基线时报告有 CAD。根据 Weston（≥7）和 Agatston（≥400）评分，分别有 413 名（22.0%）和 241 名（12.9%）患者存在显著的 CAC，两种方法呈显著相关性（r=0.84；P<0.001）。在 5 年的随访期间，127 名患者（6.8%）发生了新发 CVD。对于预测现患 CAD，Weston 和 Agatston 评分的 c 指数分别为 0.78 和 0.74，对于预测新发 CVD，其 c 指数分别为 0.62 和 0.61。在调整年龄、种族、性别、吸烟包年数、FEV、肺气肿百分比和 CT 扫描仪类型后，Weston 评分≥7 与首次急性冠脉事件的时间相关（危险比，2.16[95%CI，1.32 至 3.53]；P=0.002），而 Agatston 评分≥400 则不相关（危险比，1.75[95%CI，0.99 至 3.09]；P=0.053）。
对于有和无 COPD 的吸烟者，CAC 的简单视觉评分在预测新发 CAD 方面表现良好。
ClinicalTrials.gov；编号：NCT00608764；网址：www.clinicaltrials.gov。
