Department of Vascular Medicine, University Medical Center Utrecht (UMCU), Utrecht University, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht University, Utrecht, The Netherlands.
Int J Cardiovasc Imaging. 2021 Jun;37(6):2051-2061. doi: 10.1007/s10554-021-02164-9. Epub 2021 Feb 12.
The purpose is to investigate the added prognostic value of coronary artery calcium (CAC), thoracic aortic calcium (TAC), and heart valve calcium scores for prediction of a combined endpoint of recurrent major cardiovascular events and cardiovascular interventions (MACE +) in patients with established cardiovascular disease (CVD). In total, 567 patients with established CVD enrolled in a substudy of the UCC-SMART cohort, entailing cardiovascular CT imaging and calcium scoring, were studied. Five Cox proportional hazards models for prediction of 4-year risk of MACE + were developed; traditional CVD risk predictors only (model I), with addition of CAC (model II), TAC (model III), heart valve calcium (model IV), and all calcium scores (model V). Bootstrapping was performed to account for optimism. During a median follow-up of 3.43 years (IQR 2.28-4.74) 77 events occurred (MACE+). Calibration of predicted versus observed 4-year risk for model I without calcium scores was good, and the c-statistic was 0.65 (95%CI 0.59-0.72). Calibration for models II-V was similar to model I, and c-statistics were 0.67, 0.65, 0.65, and 0.68 for model II, III, IV, and V, respectively. NRIs showed improvement in risk classification by model II (NRI 15.24% (95%CI 0.59-29.39)) and model V (NRI 20.00% (95%CI 5.59-34.92)), but no improvement for models III and IV. In patients with established CVD, addition of the CAC score improved performance of a risk prediction model with classical risk factors for the prediction of the combined endpoint MACE+ . Addition of the TAC or heart valve score did not improve risk predictions.
目的在于探究冠状动脉钙（CAC）、胸主动脉钙（TAC）和心脏瓣膜钙评分对已确诊心血管疾病（CVD）患者复发性主要心血管事件和心血管干预（MACE+）复合终点的预后价值。共有 567 名已确诊 CVD 的患者参加了 UCC-SMART 队列的子研究，接受了心血管 CT 成像和钙评分。建立了 5 个用于预测 4 年 MACE+风险的 Cox 比例风险模型；仅使用传统 CVD 风险预测因素（模型 I），并加入 CAC（模型 II）、TAC（模型 III）、心脏瓣膜钙（模型 IV）和所有钙评分（模型 V）。采用自举法来校正模型的乐观性。在中位数为 3.43 年（IQR 2.28-4.74）的随访期间，77 例事件发生（MACE+）。无钙评分的模型 I 对预测与观察到的 4 年风险的校准情况良好，C 统计量为 0.65（95%CI 0.59-0.72）。模型 II-V 的校准情况与模型 I 相似，模型 II、III、IV 和 V 的 C 统计量分别为 0.67、0.65、0.65 和 0.68。NRIs 显示模型 II（NRI 15.24%（95%CI 0.59-29.39））和模型 V（NRI 20.00%（95%CI 5.59-34.92））的风险分类得到改善，但模型 III 和 IV 则没有改善。在已确诊 CVD 的患者中，CAC 评分的加入改善了基于经典危险因素的风险预测模型对 MACE+复合终点的预测性能。TAC 或心脏瓣膜评分的加入并不能改善风险预测。
