Oishi Hideo, Horibe Hideki, Yamase Yuichiro, Ueyama Chikara, Takemoto Yoshio, Shigeta Toshimasa, Hibino Takeshi, Kondo Taizo, Suzuki Susumu, Ishii Hideki, Murohara Toyoaki
Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-cho, Tajimi, 507-8522, Japan.
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Heart Vessels. 2020 May;35(5):620-629. doi: 10.1007/s00380-019-01527-6. Epub 2019 Nov 9.
The utility of abdominal aortic calcification (AAC) for prediction of cardiovascular events (CVEs) in patients with acute coronary syndrome (ACS) remains to be determined. The aim of this prospective study was to determine the predictive value of the abdominal aortic calcification index (ACI), a semi-quantitative measure of AAC, for CVEs in patients with ACS. We evaluated 314 patients with ACS. All patients underwent successful percutaneous coronary intervention to the culprit coronary vessel without in-hospital adverse events. ACI was calculated on non-contrast computed tomography images. CVEs were defined as a composite of cardiovascular death, ACS recurrence, and stroke. During a median follow-up period of 19.1 months, CVEs occurred in 29 patients (9.2%). Multivariable regression analysis after adjustment for age and gender showed a significantly higher baseline ACI in patients with CVEs than in those without [median (interquartile ranges), 42.1 (25.9-60.2) vs. 20.8 (8.8-38.6) %; P = 0.021]. The cutoff value of ACI for prediction of CVEs, estimated by receiver-operating characteristic analysis, was 29.2%, with sensitivity of 76% and specificity of 64% (area under the curve, 0.69). After adjustment for conventional cardiovascular risk factors, Cox analysis showed high ACI (≥29.2%) to be significantly associated with increased risk of CVEs (P = 0.011; hazard ratio, 1.82). Multivariate analysis identified high ACI as an independent predictor of CVEs (P = 0.012; hazard ratio, 1.80). Stepwise forward selection procedure also showed that high ACI was a significant independent determinant of CVEs (P = 0.004; R, 0.089). Both net reclassification improvement (0.64; P = 0.001) and integrated discrimination improvement (0.04; P < 0.001) improved significantly after the addition of high ACI to conventional risk factors. Evaluation of ACI using CT seems to provide valuable clinical information for proper assessment of mid-term CVEs in patients with ACS after percutaneous coronary intervention.
腹主动脉钙化（AAC）对急性冠状动脉综合征（ACS）患者心血管事件（CVE）的预测价值尚待确定。这项前瞻性研究的目的是确定腹主动脉钙化指数（ACI）（一种AAC的半定量测量方法）对ACS患者CVE的预测价值。我们评估了314例ACS患者。所有患者均成功对罪犯冠状动脉血管进行了经皮冠状动脉介入治疗，且未发生院内不良事件。在非增强计算机断层扫描图像上计算ACI。CVE被定义为心血管死亡、ACS复发和中风的综合情况。在中位随访期19.1个月期间，29例患者（9.2%）发生了CVE。在对年龄和性别进行调整后的多变量回归分析显示，发生CVE的患者基线ACI显著高于未发生CVE的患者[中位数（四分位间距），42.1（25.9 - 60.2）%对20.8（8.8 - 38.6）%；P = 0.021]。通过受试者工作特征分析估计，预测CVE的ACI临界值为29.2%，敏感性为76%，特异性为64%（曲线下面积，0.69）。在对传统心血管危险因素进行调整后，Cox分析显示高ACI（≥29.2%）与CVE风险增加显著相关（P = 0.011；风险比，1.82）。多变量分析确定高ACI是CVE的独立预测因素（P = 0.012；风险比，1.80）。逐步向前选择程序也显示高ACI是CVE的显著独立决定因素（P = 0.004；R，0.089）。在传统危险因素中加入高ACI后，净重新分类改善（0.64；P = 0.001）和综合判别改善（0.04；P < 0.001）均有显著改善。使用CT评估ACI似乎为经皮冠状动脉介入治疗后ACS患者中期CVE的恰当评估提供了有价值的临床信息。
