Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York; Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Hanyang University Medical Center, Goyang-si, South Korea; Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York; Department of Radiology, Mayo Clinic, Rochester, Minnesota.
Am J Cardiol. 2019 May 1;123(9):1435-1442. doi: 10.1016/j.amjcard.2019.01.055. Epub 2019 Feb 10.
The prognostic performance of coronary artery calcium score (CACS) for predicting adverse outcomes in patients with decreased renal function remains unclear. We aimed to examine whether CACS improves risk stratification by demonstrating incremental value beyond a traditional risk score according to renal function status. 9,563 individuals without known coronary artery disease were enrolled. Estimated glomerular filtration rate (eGFR, ml/min/1.73 m) was ascertained using the modified Modification of Diet in Renal Disease formula, and was categorized as: ≥90, 60 to 89, and <60. CACS was categorized as 0, 1 to 100, 101 to 400, and >400. Multivariable Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (95% CI) for major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, and late revascularization (>90 days). Mean age was 55.8 ± 11.5 years (52.8% male). In total, 261 (2.7%) patients experienced MACE over a median follow-up of 24.5 months (interquartile range: 16.9 to 41.1). Incident MACE increased with higher CACS across each eGFR category, with the highest rate observed among patients with CACS >400 and eGFR <60 (95.1 per 1,000 person-years). A CACS >400 increased MACE risk with HR 4.46 (95% CI 1.68 to 11.85), 6.63 (95% CI 4.03 to 10.92), and 6.14 (95% CI 2.85 to 13.21) for eGFR ≥90, 60 to 89, and <60, respectively, as compared with CACS 0. Further, CACS improved discrimination and reclassification beyond Framingham 10-year risk score (FRS) (AUC: 0.70 vs 0.64; category free-NRI: 0.51, all p <0.001) for predicting MACE in patients with impaired renal function (eGFR < 90). In conclusion, CACS improved risk stratification and provided incremental value beyond FRS for predicting MACE, irrespective of eGFR status.
冠状动脉钙评分（CACS）预测肾功能下降患者不良结局的预后性能仍不清楚。我们旨在研究 CACS 是否通过根据肾功能状态显示出超过传统风险评分的增量价值来改善风险分层。共纳入 9563 名无已知冠状动脉疾病的个体。使用改良肾脏病饮食研究公式确定肾小球滤过率（eGFR，ml/min/1.73m），并分为：≥90、60-89 和 <60。CACS 分为 0、1-100、101-400 和 >400。多变量 Cox 回归用于估计主要不良心脏事件（MACE）的风险比（HR）和 95%置信区间（95%CI），MACE 包括全因死亡率、心肌梗死和晚期血运重建（>90 天）。平均年龄为 55.8±11.5 岁（52.8%为男性）。中位随访 24.5 个月（四分位间距 16.9 至 41.1）期间，共有 261 名（2.7%）患者发生 MACE。在每个 eGFR 类别中，随着 CACS 的升高，发生 MACE 的概率增加，在 CACS>400 和 eGFR<60 的患者中观察到最高的发生率（每 1000 人年 95.1 例）。CACS>400 与 HR 4.46（95%CI 1.68 至 11.85）、6.63（95%CI 4.03 至 10.92）和 6.14（95%CI 2.85 至 13.21）相比，eGFR≥90、60-89 和<60 的 MACE 风险分别增加，与 CACS 0 相比。此外，与 Framingham 10 年风险评分（FRS）相比（AUC：0.70 与 0.64；无分类净再分类指数：0.51，均 p<0.001），CACS 改善了肾功能受损（eGFR<90）患者预测 MACE 的风险分层和重新分类。总之，CACS 改善了风险分层，并为预测 MACE 提供了 FRS 之外的增量价值，而与 eGFR 状态无关。
