Aljizeeri Ahmed, Ahmed Ahmed Ibrahim, Alfaris Mousa Alali, Ahmed Dalia, Farea Jabir, Elneama Awadelkarim, Suliman Ihab, Alharthi Mohsen, Ahmed Amjad, Alsaileek Ahmed, Al-Mallah Mouaz H
King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, King Abdullah International Medical Research Center, and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA.
JACC Cardiovasc Imaging. 2021 Dec;14(12):2443-2452. doi: 10.1016/j.jcmg.2021.01.024. Epub 2021 Mar 17.
The aim of this analysis is to examine the incremental prognostic value of coronary artery calcium (CAC) score and myocardial flow reserve (MFR) in patients with suspected coronary artery disease (CAD) undergoing positron emission tomography (PET) myocardial perfusion imaging (MPI).
Advances in cardiac PET and computed tomography imaging enabled the simultaneous acquisition of anatomic and physiological data for patients suspected of CAD.
Consecutive patients who underwent PET MPI and CAC score calculation at King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia, between May 2011 and May 2018 were included in the study. MPI and CAC images were obtained in the same setting. The primary endpoint of the study was a composite of cardiac death and nonfatal myocardial infarction. Cox proportional hazard regression was used to assess the incremental prognostic value of CAC and MFR by sequentially adding the variables to a model that included clinical and PET variables.
A total of 4,008 patients (mean age 59.7 ± 11.6 years, 55% women) were included in the analysis. Risk factors were prevalent (77.6% hypertension, 58.1% diabetes). In total, 35.9% of the cohort had CAC of 0, 16.5% had CAC ≥400, and 43.9% had MFR <2. Over a median follow up of 1.9 years, 130 (3.2%) patients had cardiac death/nonfatal myocardial infarction. CAC and MFR score added incremental prognostic value over clinical and perfusion variables (base model: c-index 0.8137; Akaike information criterion [AIC]: 1,865.877; p = 0.0011; CAC model: c-index = 0.8330; AIC: 1,850.810; p = 0.045 vs. base model; MFR model: c-index = 0.8279; AIC: 1,859.235; p = 0.024). Combining CAC and MFR did not enhance risk prediction (c-index = 0.8435; AIC: 1,846.334; p = 0.074 vs. MFR model; p = 0.21 vs. CAC model.) CONCLUSIONS: In this large cohort of patients referred for PET MPI, both CAC and MFR independently added incremental prognostic value over clinical and MPI variables. Although combining both may have synergetic prognostic effect, this relation was not shown in multivariable model of this analysis.
本分析旨在研究冠状动脉钙化（CAC）评分和心肌血流储备（MFR）对疑似冠心病（CAD）患者进行正电子发射断层扫描（PET）心肌灌注成像（MPI）时的增量预后价值。
心脏PET和计算机断层扫描成像技术的进步使得疑似CAD患者能够同时获取解剖和生理数据。
纳入2011年5月至2018年5月在沙特阿拉伯利雅得阿卜杜勒阿齐兹国王心脏中心接受PET MPI和CAC评分计算的连续患者。MPI和CAC图像在相同条件下获取。研究的主要终点是心源性死亡和非致命性心肌梗死的复合终点。采用Cox比例风险回归，通过将变量依次添加到包含临床和PET变量的模型中，评估CAC和MFR的增量预后价值。
共纳入4008例患者（平均年龄59.7±11.6岁，55%为女性）进行分析。危险因素普遍存在（77.6%患有高血压，58.1%患有糖尿病）。总体而言，35.9%的队列CAC为0，16.5%的队列CAC≥400，43.9%的队列MFR<2。在中位随访1.9年期间，130例（3.2%）患者发生心源性死亡/非致命性心肌梗死。CAC和MFR评分在临床和灌注变量基础上增加了增量预后价值（基础模型：c指数0.8137；赤池信息准则[AIC]：1865.877；p = 0.0011；CAC模型：c指数 = 0.8330；AIC：1850.810；与基础模型相比，p = 0.045；MFR模型：c指数 = 0.8279；AIC：1859.235；p = 0.024）。联合使用CAC和MFR并未增强风险预测能力（c指数 = 0.8435；AIC：1846.334；与MFR模型相比，p = 0.074；与CAC模型相比，p = 0.21）。结论：在这一接受PET MPI的大型患者队列中，CAC和MFR在临床和MPI变量基础上均独立增加了增量预后价值。尽管两者联合可能具有协同预后作用，但在本分析的多变量模型中未显示这种关系。
