Department of Internal Medicine Seoul National University College of Medicine Seoul South Korea.
Department of Radiology Seoul National University College of Medicine and Seoul National University Bundang Hospital Seongnam South Korea.
J Am Heart Assoc. 2019 Dec 3;8(23):e013523. doi: 10.1161/JAHA.119.013523. Epub 2019 Nov 22.
Background The prognostic value of coronary computed tomographic angiography (CCTA) for evaluating coronary artery disease in asymptomatic older adults is controversial. We investigated the prognostic value of CCTA in community-dwelling elderly Koreans. Methods and Results Participants (n=470; mean age: 75.1±7.3 years) who underwent CCTA were enrolled from KLoSHA (Korean Longitudinal Study on Health and Aging), a community-based prospective cohort. Using CCTA, coronary artery disease was classified as , or according to the presence of 0%, <50%, or ≥50% stenosis, respectively. Coronary artery calcium scores were investigated together with Framingham risk score, atherosclerotic cardiovascular disease score, and individual risk factors. Major adverse cardiac events (MACE) were defined as a composite of cardiac event-related death or nonfatal myocardial infarction. During a median follow-up of 8.2 years (interquartile range: 7.7-10.1 years), MACE occurred in 24 participants (5.1%). Compared with the normal group, participants in the obstructive group showed higher incidence of MACE (hazard ratio: 5.65; 95% CI, 1.22-26.16; =0.027), whereas there were no significant differences in MACE between the normal and nonobstructive groups. The 8-year event-free survival rates were 98.1±1.1%, 94.9±1.6%, and 81.7±4.8% in the normal, nonobstructive, and obstructive groups, respectively. Compared with the Framingham risk score and coronary artery calcium score model, CCTA improved risk prediction by C-index (from 0.698 to 0.749) and category-free net reclassification index (0.478; =0.022). Conclusions CCTA showed better long-term prognostic value for MACE than coronary artery calcium score in this asymptomatic older population.
对于无症状老年人群，冠状动脉 CT 血管造影（CCTA）评估冠状动脉疾病的预后价值存在争议。本研究旨在探讨 CCTA 在社区居住的韩国老年人中的预后价值。
参与者（n=470；平均年龄：75.1±7.3 岁）来自 KLoSHA（韩国健康老龄化纵向研究），这是一项社区为基础的前瞻性队列研究。使用 CCTA，根据 0%、<50%或≥50%狭窄的存在情况，冠状动脉疾病分别被分类为 0 级、1 级或 2 级。还研究了冠状动脉钙评分与 Framingham 风险评分、动脉粥样硬化性心血管疾病评分和个体危险因素的关系。主要不良心脏事件（MACE）定义为与心脏事件相关的死亡或非致死性心肌梗死的复合终点。中位随访时间为 8.2 年（四分位间距：7.7-10.1 年），24 名参与者（5.1%）发生了 MACE。与正常组相比，阻塞组的 MACE 发生率更高（风险比：5.65；95%CI，1.22-26.16；=0.027），而正常组与非阻塞组之间的 MACE 发生率无显著差异。在正常、非阻塞和阻塞组中，8 年无事件生存率分别为 98.1±1.1%、94.9±1.6%和 81.7±4.8%。与Framingham 风险评分和冠状动脉钙评分模型相比，CCTA 通过 C 指数（从 0.698 提高至 0.749）和分类净重新分类指数（0.478；=0.022）改善了风险预测。
在该无症状老年人群中，与冠状动脉钙评分相比，CCTA 对 MACE 的长期预后预测价值更高。
