From the, Department of Cardiovascular Radiology, Texas Heart Institute, Houston, TX, USA.
Department of Diagnostic and Interventional Radiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA.
J Intern Med. 2021 Mar;289(3):309-324. doi: 10.1111/joim.13176. Epub 2020 Oct 5.
Primary care physicians often must decide whether statin therapy would be appropriate (in addition to lifestyle modification) for managing asymptomatic individuals with borderline or intermediate risk for developing atherosclerotic cardiovascular disease (ASCVD), as assessed on the basis of traditional risk factors. In appropriate subjects, a simple, noninvasive measurement of coronary artery calcium can help clarify risk. Coronary atherosclerosis is a chronic inflammatory disease, with atherosclerotic plaque formation involving intimal inflammation and repeated cycles of erosion and fibrosis, healing and calcification. Atherosclerotic plaque formation represents the prognostic link between risk factors and future clinical events. The presence of coronary artery calcification is almost exclusively an indication of coronary artery disease, except in certain metabolic conditions. Coronary artery calcification can be detected and quantified in a matter of seconds by noncontrast electrocardiogram-gated low-dose X-ray computed tomography (coronary artery calcium scoring [CACS]). Since the publication of the seminal work by Dr. Arthur Agatston in 1990, a wealth of CACS-based prognostic data has been reported. In addition, recent guidelines from various professional societies conclude that CACS may be considered as a tool for reclassifying risk for atherosclerotic cardiovascular disease in patients otherwise assessed to have intermediate risk, so as to more accurately inform decisions about possible statin therapy in addition to lifestyle modification as primary preventive therapy. In this review, we provide an overview of CACS, from acquisition to interpretation, and summarize the scientific evidence for and the appropriate use of CACS as put forth in current clinical guidelines.
初级保健医生通常必须决定是否对患有动脉粥样硬化性心血管疾病（ASCVD）边缘或中度风险的无症状个体（除了生活方式改变外）进行他汀类药物治疗，这是基于传统风险因素进行评估的。在合适的患者中，冠状动脉钙的简单、非侵入性测量有助于明确风险。冠状动脉粥样硬化是一种慢性炎症性疾病，涉及内膜炎症和反复侵蚀纤维化、愈合和钙化的动脉粥样斑块形成。动脉粥样硬化斑块的形成代表了危险因素与未来临床事件之间的预后联系。冠状动脉钙化的存在几乎完全是冠状动脉疾病的指征，除了某些代谢条件外。通过非对比心电图门控低剂量 X 射线计算机断层扫描（冠状动脉钙评分[CACS]）可以在几秒钟内检测和定量冠状动脉钙化。自 1990 年 Arthur Agatston 博士发表开创性工作以来，已经报告了大量基于 CACS 的预后数据。此外，来自不同专业协会的最新指南得出结论，CACS 可被视为重新分类具有中间风险的动脉粥样硬化性心血管疾病患者风险的工具，以便更准确地告知关于可能的他汀类药物治疗以及除生活方式改变以外的一级预防治疗的决策。在这篇综述中，我们从采集到解释的角度概述了 CACS，并总结了当前临床指南中提出的 CACS 的科学证据及其适当应用。
