升主动脉钙化是急性冠状动脉综合征患者冠状动脉疾病严重程度的一个强有力的预测因子。
Aortic Arch Calcification Is a Strong Predictor of the Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome.
机构信息
Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing 100029, China.
Department of Cardiology, Qingdao Municipal Hospital, Qingdao 266000, China.
出版信息
Biomed Res Int. 2019 Aug 7;2019:7659239. doi: 10.1155/2019/7659239. eCollection 2019.
BACKGROUND
The purpose of this study was to investigate the correlation of the extent of aortic arch calcification (AAC) detectable on chest X-rays with the severity of coronary artery disease (CAD) as evaluated by the SYNTAX score (SS) in patients with acute coronary syndrome (ACS).
METHODS
A total of 1,418 patients (344 women; 59 ± 10 years) who underwent coronary angiography for ACS and were treated with coronary revascularization were included in the present study; chest X-rays were performed on admission. The AAC extent was divided into four grades (0-3). SS was calculated based on each patient's coronary angiographic findings. The relationship between the AAC extent and SS was assessed.
RESULTS
The AAC extent was positively correlated with SS ( = 0.639, < 0.001). In the multivariate analysis, compared with grade 0, odds ratios (ORs) of AAC grades 1, 2, and 3 in predicting SS >22 were 12.95 (95% CI, 7.85-21.36), 191.76 (95% CI, 103.17-356.43), and 527.81 (95% CI, 198.24-1405.28), respectively. Receiver operating characteristic curve analysis yielded a strong predictive ability of the AAC extent for SS >22 (area under curve = 0.840, < 0.001). Absence of AAC had a sensitivity, specificity, positive prognostic value, negative prognostic value, and accuracy of 46.7%, 95.9%, 94.1%, 56.4%, and 67.3%, respectively, for SS ≤22. AAC grades ≥2 had a sensitivity of 66.3%, specificity of 89.2%, positive prognostic value of 81.5%, negative prognostic value of 78.6%, and accuracy of 79.6% for the correct identification of SS >22.
CONCLUSIONS
The extent of AAC detectable on chest X-rays might provide valuable information in predicting CAD severity in ACS patients.
背景
本研究旨在探讨胸部 X 射线检测到的主动脉弓钙化（AAC）程度与急性冠脉综合征（ACS）患者冠状动脉疾病（CAD）严重程度（通过 SYNTAX 评分（SS）评估）之间的相关性。
方法
本研究共纳入 1418 例因 ACS 接受冠状动脉造影并接受冠状动脉血运重建治疗的患者（344 例女性，年龄 59±10 岁）；入院时进行了胸部 X 射线检查。AAC 程度分为四级（0-3 级）。根据每位患者的冠状动脉造影结果计算 SS。评估 AAC 程度与 SS 之间的关系。
结果
AAC 程度与 SS 呈正相关（ = 0.639， < 0.001）。多因素分析显示，与 AAC 0 级相比，AAC 1 级、2 级和 3 级预测 SS>22 的优势比（OR）分别为 12.95（95%可信区间，7.85-21.36）、191.76（95%可信区间，103.17-356.43）和 527.81（95%可信区间，198.24-1405.28）。受试者工作特征曲线分析显示，AAC 程度对 SS>22 具有较强的预测能力（曲线下面积=0.840， < 0.001）。无 AAC 对 SS≤22 的预测能力分别为敏感性 46.7%、特异性 95.9%、阳性预测值 94.1%、阴性预测值 56.4%和准确性 67.3%。AAC 分级≥2 对 SS>22 的识别具有敏感性 66.3%、特异性 89.2%、阳性预测值 81.5%、阴性预测值 78.6%和准确性 79.6%。
结论
胸部 X 射线检测到的 AAC 程度可能为预测 ACS 患者 CAD 严重程度提供有价值的信息。
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