Zimmermann Gregor S, Rüther Tobias, Ziegler Franz V, Greif Martin, Becker Christoph, Becker Alexander
Department of Internal Medicine I, Division of Respiratory Diseases, Klinikum Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
Department of Psychiatry, Ludwig-Maximilians-University Munich, Munich, Germany.
Int J Cardiovasc Imaging. 2019 Jul;35(7):1387-1393. doi: 10.1007/s10554-019-01571-3. Epub 2019 Mar 6.
Coronary calcification (CAC) is an established marker for coronary atherosclerosis and has a highly specific predictive value for cardiovascular events. This study aimed to determine the predictive value in the specific group of asymptomatic smokers in comparison to non-smokers. We included 1432 asymptomatic individuals (575 women, 857 men, age 59.2 ± 7.7 years.) in this study. Coronary calcification was calculated by multi-slice computed tomography following a standardized protocol including calcium score (CS). Coronary risk factors were determined at inclusion. After mean observation time of 76.3 ± 8.5 months the patients were contacted and evaluated for cardiovascular events (myocardial infarction, cardiac death and revascularisation). Mean CS was 231 ± 175 in smokers and 239 ± 188 in non-smokers. Cardiovascular events were found in 14.9% of our patients and there were significantly more events in smokers (119 events, 8.3%) than in non-smokers (94 events, 6.6%, p = 0.001). CS > 400 showed a hazard ratio for future cardiac events of 5.1 (95% CI 4.3-7.6) in smokers and 4.4 (95% CI 3.4-6.2) in non-smokers, p = 0.01. Also in smokers determination of CAC is a valuable predictor of future cardiovascular events. In our study smokers showed throughout all score groups a significantly higher risk compared to non-smokers with equal CS. Therefore, CS may underestimate the risk for future cardiac events in smokers compared to non-smokers.
冠状动脉钙化（CAC）是冠状动脉粥样硬化的既定标志物，对心血管事件具有高度特异性的预测价值。本研究旨在确定无症状吸烟者这一特定群体与非吸烟者相比的预测价值。我们纳入了1432名无症状个体（575名女性，857名男性，年龄59.2±7.7岁）参与本研究。按照包括钙评分（CS）在内的标准化方案，通过多层计算机断层扫描计算冠状动脉钙化。在纳入时确定冠状动脉危险因素。经过平均76.3±8.5个月的观察期后，对患者进行随访并评估心血管事件（心肌梗死、心源性死亡和血运重建）。吸烟者的平均CS为231±175，非吸烟者为239±188。我们的患者中有14.9%发生了心血管事件，吸烟者发生的事件（119例，8.3%）明显多于非吸烟者（94例，6.6%，p = 0.001）。CS>400时，吸烟者未来发生心脏事件的风险比为5.1（95%CI 4.3 - 7.6），非吸烟者为4.4（95%CI 3.4 - 6.2），p = 0.01。对于吸烟者而言，测定CAC也是未来心血管事件的有价值预测指标。在我们的研究中，与CS相同的非吸烟者相比，吸烟者在所有评分组中均显示出明显更高的风险。因此，与非吸烟者相比，CS可能低估了吸烟者未来发生心脏事件的风险。
