1 Department of Cardiology Johns Hopkins Hospital and School of Medicine Baltimore MD.
2 Department of Cardiology Erasmus Medical Center Erasmus University Rotterdam Rotterdam the Netherlands.
J Am Heart Assoc. 2019 Mar 19;8(6):e007201. doi: 10.1161/JAHA.117.007201.
Background The predictive value of coronary artery calcium ( CAC ) has been widely studied; however, little is known about specific characteristics of CAC that are most predictive. We aimed to determine the independent associations of Agatston score, CAC volume, CAC area, CAC mass, and CAC density score with major adverse cardiac events in patients with suspected coronary artery disease. Methods and Results A total of 379 symptomatic participants, aged 45 to 85 years, referred for invasive coronary angiography, who underwent coronary calcium scanning and computed tomography angiography as part of the CORE 320 (Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320 Detector Computed Tomography) study, were included. Agatston score, CAC volume, area, mass, and density were computed on noncontrast images. Stenosis measurements were made on contrast-enhanced images. The primary outcome of 2-year major adverse cardiac events (30 revascularizations [>182 days of index catheterization], 5 myocardial infarctions, 1 cardiac death, 9 hospitalizations, and 1 arrhythmia) occurred in 32 patients (8.4%). Associations were estimated using multivariable proportional means models. Median age was 62 (interquartile range, 56-68) years, 34% were women, and 56% were white. In separate models, the Agatston, volume, and density scores were all significantly associated with higher risk of major adverse cardiac events after adjustment for age, sex, race, and statin use; density was the strongest predictor in all CAC models. CAC density did not provide incremental value over Agatston score after adjustment for diameter stenosis, age, sex, and race. Conclusions In symptomatic patients, CAC density was the strongest independent predictor of major adverse cardiac events among CAC scores, but it did not provide incremental value beyond the Agatston score after adjustment for diameter stenosis.
背景 冠状动脉钙（CAC）的预测价值已得到广泛研究；然而，对于最具预测性的 CAC 特定特征知之甚少。我们旨在确定 Agatston 评分、CAC 体积、CAC 面积、CAC 质量和 CAC 密度评分与疑似冠心病患者主要不良心脏事件的独立相关性。
方法和结果 共有 379 名年龄在 45 至 85 岁之间的有症状参与者因疑似冠状动脉疾病接受了侵入性冠状动脉造影，他们作为 CORE 320（使用 320 探测器计算机断层扫描进行联合非侵入性冠状动脉造影和心肌灌注成像）研究的一部分接受了冠状动脉钙扫描和计算机断层血管造影。在非对比图像上计算了 Agatston 评分、CAC 体积、面积、质量和密度。在对比增强图像上进行了狭窄测量。主要终点为 2 年主要不良心脏事件（30 例血管重建术[>182 天指数导管插入术]、5 例心肌梗死、1 例心脏死亡、9 例住院和 1 例心律失常）发生在 32 例患者（8.4%）中。使用多变量比例平均值模型估计相关性。中位年龄为 62 岁（四分位间距，56-68 岁），34%为女性，56%为白人。在单独的模型中，在调整年龄、性别、种族和他汀类药物使用后，Agatston、体积和密度评分均与主要不良心脏事件的高风险显著相关；在所有 CAC 模型中，密度是最强的预测因子。在调整直径狭窄、年龄、性别和种族后，CAC 密度评分在 Agatston 评分之上并未提供增量价值。
结论 在有症状的患者中，CAC 密度是 CAC 评分中预测主要不良心脏事件的最强独立预测因子，但在调整直径狭窄后，与 Agatston 评分相比，并未提供额外的价值。
