中重度冠状动脉钙化可预测 CT 肺癌筛查患者的长期心血管死亡：ITALUNG 试验。
Moderate-severe coronary calcification predicts long-term cardiovascular death in CT lung cancer screening: The ITALUNG trial.
机构信息
Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy; Clinical Epidemiology and Clinical Governance Support Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy.
Clinical Epidemiology and Clinical Governance Support Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy.
出版信息
Eur J Radiol. 2021 Dec;145:110040. doi: 10.1016/j.ejrad.2021.110040. Epub 2021 Nov 16.
PURPOSE
Coronary artery calcifications (CAC) are very strong indicators for increased cardio-vascular (CV) risk and can be evaluated also in low-dose computed tomography (LDCT) for lung cancer screening. We assessed whether a simple and fast CAC visual score is associated with CV mortality.
METHODS
CAC were retrospectively assessed by two observers using a 4-score (absent, mild, moderate and severe) scale in baseline LDCT obtained in 1364 participants to the ITALUNG trial who had 55-69 years of age and a smoking history ≥20 pack-years. Correlations with CV risk factors at baseline and with CV mortality after 11 years of follow-up were investigated.
RESULTS
CAC were absent in 470 (34.5%), mild in 433 (31.7%), moderate in 357 (26.2%) and severe in 104 (7.6%) subjects. CAC severity correlated (≤0.001) with age, male sex, pack-years, history of arterial hypertension or diabetes, obesity and treated hypercholesterolemia. Twenty-one CV deaths occurred. Moderate or severe CAC were significantly associated with higher CV mortality after adjustment for all other known risk factors (ARR = 2.72; 95 %CI:1.04-7.11). Notably, also in subjects with none or one only additional CV risk factor, the presence of moderate-severe CAC allowed to identify a subgroup of subjects with higher CV death risk (RR = 3.66; CI95%:1.06-12.6).
CONCLUSIONS
Moderate or severe CAC visually assessed in LDCT examinations for lung cancer screening are independently associated with CV mortality.
目的
冠状动脉钙化（CAC）是心血管（CV）风险增加的非常强的指标，也可以在用于肺癌筛查的低剂量计算机断层扫描（LDCT）中进行评估。我们评估了简单快速的 CAC 视觉评分是否与 CV 死亡率相关。
方法
在 ITALUNG 试验中，1364 名年龄在 55-69 岁且吸烟史≥20 包年的参与者的基线 LDCT 中，由两名观察者使用 4 分制（无、轻度、中度和重度）对 CAC 进行回顾性评估。研究了 CAC 与基线 CV 危险因素的相关性以及 11 年后的 CV 死亡率。
结果
CAC 无的有 470 例（34.5%），轻度的有 433 例（31.7%），中度的有 357 例（26.2%），重度的有 104 例（7.6%）。CAC 严重程度与年龄、男性、吸烟包年数、高血压或糖尿病病史、肥胖和治疗性高胆固醇血症显著相关（≤0.001）。发生了 21 例 CV 死亡。在调整所有其他已知危险因素后，中度或重度 CAC 与更高的 CV 死亡率显著相关（ARR=2.72；95%CI：1.04-7.11）。值得注意的是，即使在仅有一个或一个以上其他 CV 危险因素的患者中，中重度 CAC 的存在也可以确定一个具有更高 CV 死亡风险的亚组（RR=3.66；CI95%：1.06-12.6）。
结论
在用于肺癌筛查的 LDCT 检查中，视觉评估的中度或重度 CAC 与 CV 死亡率独立相关。
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