冠状动脉 CT 血管造影 CAD-RADS 与急性胸痛患者的冠状动脉钙化积分比较。
Coronary CT Angiography CAD-RADS versus Coronary Artery Calcium Score in Patients with Acute Chest Pain.
机构信息
Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea (J.W.L.); Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea (J.Y.K.); Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea (K.H., D.J.I., K.H.L., J.H.); and Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (T.H.K., C.H.P.).
出版信息
Radiology. 2021 Oct;301(1):81-90. doi: 10.1148/radiol.2021204704. Epub 2021 Jul 20.
Background The Coronary Artery Disease Reporting and Data System (CAD-RADS) was established in 2016 to standardize the reporting of coronary artery disease at coronary CT angiography (CCTA). Purpose To assess the prognostic value of CAD-RADS at CCTA for major adverse cardiovascular events (MACEs) in patients presenting to the emergency department with chest pain. Materials and Methods This multicenter retrospective observational cohort study was conducted at four qualifying university teaching hospitals. Patients presenting to the emergency department with acute chest pain underwent CCTA between January 2010 and December 2017. Multivariable Cox regression analysis was used to evaluate risk factors for MACEs, including clinical factors, coronary artery calcium score (CACS), and CAD-RADS categories. The prognostic value compared with clinical risk factors and CACS was also assessed. Results A total of 1492 patients were evaluated (mean age, 58 years ± 14 years [standard deviation]; 759 men). During a median follow-up period of 31.5 months, 103 of the 1492 patients (7%) experienced MACEs. Multivariable Cox regression analysis showed that a moderate to severe CACS was associated with MACEs after adjusting for clinical risk factors (hazard ratio [HR] range, 2.3-4.4; value range, <.001 to <.01). CAD-RADS categories from 3 to 4 or 5 (HR range, 3.2-8.5; < .001) and high-risk plaques (HR = 3.6, < .001) were also associated with MACEs. The C statistics revealed that the CAD-RADS score improved risk stratification more than that using clinical risk factors alone or combined with CACS (C-index, 0.85 vs 0.63 [ < .001] and 0.76 [ < .01], respectively). Conclusion The Coronary Artery Disease Reporting and Data System classification had an incremental prognostic value compared with the coronary artery calcium score in the prediction of major adverse cardiovascular events in patients presenting to the emergency department with acute chest pain. © RSNA, 2021 . See also the editorial by Vliegenthart in this issue.
背景
冠状动脉疾病报告和数据系统（CAD-RADS）于 2016 年成立，旨在规范冠状动脉 CT 血管造影（CCTA）中冠状动脉疾病的报告。目的：评估 CAD-RADS 在 CCTA 对因胸痛就诊于急诊科的患者发生主要不良心血管事件（MACE）的预后价值。材料与方法：本多中心回顾性观察性队列研究在 4 家符合条件的大学教学医院进行。2010 年 1 月至 2017 年 12 月，因急性胸痛就诊于急诊科的患者接受 CCTA。采用多变量 Cox 回归分析评估 MACE 的危险因素，包括临床因素、冠状动脉钙评分（CACS）和 CAD-RADS 类别。还评估了与临床危险因素和 CACS 的预后价值比较。结果：共评估了 1492 例患者（平均年龄，58 岁±14 岁[标准差]；759 例男性）。在中位随访 31.5 个月期间，1492 例患者中有 103 例（7%）发生了 MACE。多变量 Cox 回归分析显示，在调整临床危险因素后，中重度 CACS 与 MACE 相关（危险比范围，2.3-4.4；P 值范围，<.001 至<.01）。CAD-RADS 3 至 4 或 5 类别（危险比范围，3.2-8.5；<.001）和高危斑块（HR=3.6，<.001）也与 MACE 相关。C 统计数据显示，CAD-RADS 评分比单独使用临床危险因素或与 CACS 联合使用时更能改善风险分层（C 指数，0.85 比 0.63[<.001]和 0.76[<.01]）。结论：与冠状动脉钙评分相比，CAD-RADS 分类在预测因胸痛就诊于急诊科的患者发生主要不良心血管事件方面具有增量预后价值。©RSNA，2021。在本期中还可以看到 Vliegenthart 的社论。
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