冠状动脉钙化数据和报告系统（CAC-DRS）的验证：冠状动脉钙化（CAC）联合会中 CAC 评分和 CAC 分布的双重重要性。
Validation of the Coronary Artery Calcium Data and Reporting System (CAC-DRS): Dual importance of CAC score and CAC distribution from the Coronary Artery Calcium (CAC) consortium.
机构信息
Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, United States; Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Radiology and Neuroradiology, Charité, Berlin, Germany.
Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, United States; Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD, United States.
出版信息
J Cardiovasc Comput Tomogr. 2020 Jan-Feb;14(1):12-17. doi: 10.1016/j.jcct.2019.03.011. Epub 2019 Mar 28.
BACKGROUND
The Coronary Artery Calcium Data and Reporting System (CAC-DRS), which takes into account the Agatston score category (A) and the number of calcified vessels (N) has not yet been validated in terms of its prognostic significance.
METHODS
We included 54,678 patients from the CAC Consortium, a large retrospective clinical cohort of asymptomatic individuals free of baseline cardiovascular disease (CVD). CAC-DRS groups were derived from routine, cardiac-gated CAC scans. Cox proportional hazards regression models, adjusted for traditional CVD risk factors, were used to assess the association between CAC-DRS groups and CHD, CVD, and all-cause mortality. CAC-DRS was then compared to CAC score groups and regional CAC distribution using area under the curve (AUC) analysis.
RESULTS
The study population had a mean age of 54.2 ± 10.7, 34.4% female, and mean ASCVD score 7.3% ± 9.0. Over a mean follow-up of 12 ± 4 years, a total of 2,469 deaths (including 398 CHD deaths and 762 CVD deaths) were recorded. There was a graded risk for CHD, CVD and all-cause mortality with increasing CAC-DRS groups ranging from an all-cause mortality rate of 1.2 per 1,000 person-years for A0 to 15.4 per 1,000 person-years for A3/N4. In multivariable-adjusted models, those with CAC-DRS A3/N4 had significantly higher risk for CHD mortality (HR 5.9 (95% CI 3.6-9.9), CVD mortality (HR4.0 (95% CI 2.8-5.7), and all-cause mortality a (HR 2.5 (95% CI 2.1-3.0) compared to CAC-DRS A0. CAC-DRS had higher AUC than CAC score groups (0.762 vs 0.754, P < 0.001) and CAC distribution (0.762 vs 0.748, P < 0.001).
CONCLUSION
The CAC-DRS system, combining the Agatston score and the number of vessels with CAC provides better stratification of risk for CHD, CVD, and all-cause death than the Agatston score alone. These prognostic data strongly support new SCCT guidelines recommending the use CAC-DRS scoring.
背景
冠状动脉钙化数据和报告系统（CAC-DRS）考虑了 Agatston 评分类别（A）和钙化血管数量（N），但其预后意义尚未得到验证。
方法
我们纳入了来自 CAC 联盟的 54678 例无症状个体的大型回顾性临床队列，这些个体在基线时无心血管疾病（CVD）。CAC-DRS 组由常规的心脏门控 CAC 扫描得出。使用 Cox 比例风险回归模型，调整了传统 CVD 危险因素，评估 CAC-DRS 组与 CHD、CVD 和全因死亡率之间的关联。然后使用曲线下面积（AUC）分析比较 CAC-DRS 与 CAC 评分组和区域性 CAC 分布。
结果
研究人群的平均年龄为 54.2±10.7 岁，34.4%为女性，平均 ASCVD 评分 7.3%±9.0%。在平均 12±4 年的随访期间，共记录了 2469 例死亡（包括 398 例 CHD 死亡和 762 例 CVD 死亡）。随着 CAC-DRS 组的增加，CHD、CVD 和全因死亡率呈梯度升高，范围从 A0 组的每 1000 人年 1.2 例死亡到 A3/N4 组的每 1000 人年 15.4 例死亡。在多变量调整模型中，与 CAC-DRS A0 相比，CAC-DRS A3/N4 患者的 CHD 死亡率（HR 5.9（95%CI 3.6-9.9）、CVD 死亡率（HR 4.0（95%CI 2.8-5.7）和全因死亡率（HR 2.5（95%CI 2.1-3.0）显著更高。与 CAC-DRS A0 相比，CAC-DRS 有更高的 AUC 值（0.762 比 0.754，P<0.001）和 CAC 分布（0.762 比 0.748，P<0.001）。
结论
CAC-DRS 系统结合了 Agatston 评分和有 CAC 的血管数量，比单独使用 Agatston 评分能更好地分层 CHD、CVD 和全因死亡风险。这些预后数据有力支持了新的 SCCT 指南建议使用 CAC-DRS 评分。
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