冠状动脉钙评分零的保质期：MESA 的综合分析。
Warranty Period of a Calcium Score of Zero: Comprehensive Analysis From MESA.
机构信息
Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Radiology and Neuroradiology, Charité, Berlin, Germany.
Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
出版信息
JACC Cardiovasc Imaging. 2021 May;14(5):990-1002. doi: 10.1016/j.jcmg.2020.06.048. Epub 2020 Oct 28.
OBJECTIVES
This study sought to quantify and model conversion of a normal coronary artery calcium (CAC) scan to an abnormal CAC scan.
BACKGROUND
Although the absence of CAC is associated with excellent prognosis, progression to CAC >0 confers increased risk. The time interval for repeated scanning remains poorly defined.
METHODS
This study included 3,116 participants from the MESA (Multi-Ethnic Study of Atherosclerosis) with baseline CAC = 0 and follow-up scans over 10 years after baseline. Prevalence of incident CAC, defined by thresholds of CAC >0, CAC >10, or CAC >100, was calculated and time to progression was derived from a Weibull parametric survival model. Warranty periods were modeled as a function of sex, race/ethnicity, cardiovascular risk, and desired yield of repeated CAC testing. Further analysis was performed of the proportion of coronary events occurring in participants with baseline CAC = 0 that preceded and followed repeated CAC testing at different time intervals.
RESULTS
Mean participants' age was 58 ± 9 years, with 63% women, and mean 10-year cardiovascular risk of 14%. Prevalence of CAC >0, CAC >10, and CAC >100 was 53%, 36%, and 8%, respectively, at 10 years. Using a 25% testing yield (number needed to scan [NNS] = 4), the estimated warranty period of CAC >0 varied from 3 to 7 years depending on sex and race/ethnicity. Approximately 15% of participants progressed to CAC >10 in 5 to 8 years, whereas 10-year progression to CAC >100 was rare. Presence of diabetes was associated with significantly shorter warranty period, whereas family history and smoking had small effects. A total of 19% of all 10-year coronary events occurred in CAC = 0 prior to performance of a subsequent scan at 3 to 5 years, whereas detection of new CAC >0 preceded 55% of future events and identified individuals at 3-fold higher risk of coronary events.
CONCLUSIONS
In a large population of individuals with baseline CAC = 0, study data provide a robust estimation of the CAC = 0 warranty period, considering progression to CAC >0, CAC >10, and CAC >100 and its impact on missed versus detectable 10-year coronary heart disease events. Beyond age, sex, race/ethnicity, diabetes also has a significant impact on the warranty period. The study suggests that evidence-based guidance would be to consider rescanning in 3 to 7 years depending on individual demographics and risk profile.
目的
本研究旨在量化并建立模型以预测正常冠状动脉钙（CAC）扫描转为异常 CAC 扫描的情况。
背景
虽然无 CAC 与极佳的预后相关，但 CAC＞0 提示风险增加。重复扫描的时间间隔仍不明确。
方法
本研究纳入了基线 CAC=0 且基线后 10 年内进行了随访扫描的 MESA（多民族动脉粥样硬化研究）中的 3116 名参与者。通过 CAC＞0、CAC＞10、CAC＞100 的阈值来定义 CAC 的发生率，并从威布尔参数生存模型中得出进展时间。将保险期限建模为性别、种族/民族、心血管风险和重复 CAC 检测的预期检出率的函数。还对不同时间间隔重复 CAC 检测前后基线 CAC=0 的参与者中发生的冠状动脉事件比例进行了进一步分析。
结果
参与者的平均年龄为 58±9 岁，其中 63%为女性，平均 10 年心血管风险为 14%。10 年后 CAC＞0、CAC＞10 和 CAC＞100 的发生率分别为 53%、36%和 8%。使用 25%的检测检出率（需要扫描的数量 [NNS] = 4），CAC＞0 的保险期限因性别和种族/民族而异，范围为 3 年至 7 年。约 15%的参与者在 5 至 8 年内进展为 CAC＞10，而 10 年进展为 CAC＞100 则很少见。患有糖尿病与保险期限明显缩短相关，而家族史和吸烟则有较小的影响。所有 10 年冠状动脉事件中有 19%发生在基线 CAC=0 之前，且在此后 3 至 5 年内进行了后续扫描，而新的 CAC＞0 检测出 55%的未来事件，并确定了 3 倍于冠状动脉事件风险的个体。
结论
在基线 CAC=0 的大量人群中，研究数据提供了对 CAC=0 保险期限的稳健估计，考虑了 CAC＞0、CAC＞10 和 CAC＞100 的进展情况及其对漏诊和可检测的 10 年冠心病事件的影响。除年龄、性别、种族/民族外，糖尿病对保险期限也有显著影响。研究表明，基于证据的指南建议根据个体的人口统计学和风险状况在 3 至 7 年内进行重新扫描。
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