Cardiology Department, Hospital de Santa Cruz, Carnaxide, Portugal.
Cardiology Department, Hospital de Santa Cruz, Carnaxide, Portugal; Advanced Cardiovascular Imaging Unit, Hospital da Luz, Lisbon, Portugal.
Rev Port Cardiol (Engl Ed). 2021 Jan;40(1):25-30. doi: 10.1016/j.repc.2020.04.011. Epub 2020 Dec 7.
Coronary artery calcium (CAC) scoring is used for both cardiovascular risk reclassification and as a gatekeeper for coronary computed tomography angiography (CCTA). The aims of this study were to assess to what extent CAC score results can reclassify the cardiovascular risk of patients without obstructive coronary artery disease (CAD) on CCTA, and to measure the proportion of these patients whose primary prevention medication is changed after the exam.
In a retrospective analysis of a multicenter registry of individuals who underwent CCTA for suspected CAD during a two-year period, the Systematic COronary Risk Evaluation (SCORE) and Multi-Ethnic Study of Atherosclerosis (MESA) risk scores were calculated for each individual. In a subset of 184 patients, we also assessed the prescription of statins and antiplatelet agents before and after the test.
A total of 467 patients (248 women, mean age 60±9.10 years) were included. Median CAC score was 0 (interquartile range 0-40). Overall, 249 patients (53%) and 159 (34%) were classified as being of moderate/intermediate risk according to the SCORE and MESA risk scores, respectively. Among these, 29 (12%) and 30 (19%) patients had CAC score >100 AU, making them eligible for statin therapy. The inclusion of CAC scoring in the MESA score resulted in the reclassification of 215 patients (46%). The proportion of patients who were prescribed statins or antiplatelet agents did not change significantly after the test.
CAC scoring can reclassify cardiovascular risk in a significant proportion of patients undergoing CCTA. Despite this, little change was seen in the prescription of statins and antiplatelet agents.
冠状动脉钙化（CAC）评分既用于心血管风险再分类，也用于冠状动脉计算机断层扫描血管造影（CCTA）的准入标准。本研究的目的是评估 CAC 评分结果在多大程度上可以重新分类无阻塞性冠状动脉疾病（CAD）的 CCTA 患者的心血管风险，并测量这些患者中有多少人的一级预防药物在检查后发生了变化。
对两年期间因疑似 CAD 而行 CCTA 的多中心患者进行回顾性分析，为每位患者计算系统性冠状动脉风险评估（SCORE）和多民族动脉粥样硬化研究（MESA）风险评分。在 184 名患者的亚组中，我们还评估了测试前后他汀类药物和抗血小板药物的处方情况。
共纳入 467 例患者（248 例女性，平均年龄 60±9.10 岁）。中位 CAC 评分为 0（四分位距 0-40）。总体而言，249 例（53%）和 159 例（34%）患者根据 SCORE 和 MESA 风险评分分别被归类为中/高度风险。其中，29 例（12%）和 30 例（19%）患者的 CAC 评分>100 AU，符合他汀类药物治疗标准。在 MESA 评分中纳入 CAC 评分使 215 例患者（46%）的风险分类发生了变化。测试后，患者服用他汀类药物或抗血小板药物的比例没有显著变化。
CAC 评分可使行 CCTA 的患者中很大一部分患者的心血管风险重新分类。尽管如此，他汀类药物和抗血小板药物的处方并没有明显变化。
