Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou 510120, China; Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou 510120, China.
Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou 510120, China.
Eur J Radiol. 2022 Feb;147:110134. doi: 10.1016/j.ejrad.2021.110134. Epub 2021 Dec 29.
This study aimed to clarify the relationship between the severity of the calcium burden in the most calcified coronary vessel and coronary artery disease (CAD).
Of 2150 patients, 376 examined by both coronary computed tomographic angiography and invasive coronary angiography (ICA) within 30 days at Sun Yat-sen Memorial Hospital between March 2011 and July 2020 were included. Three coronary artery calcium scores (CACSs), including the Agatston score, volume score, and mass score, and other clinical variables were recorded. The ratio of max-to-mean CACS in the most calcified vessel (CACS) was defined as the CACS in the most calcified vessel/average CACS of the four major epicardial coronary arteries. Logistic regression and least absolute shrinkage and selection operator (LASSO) analyses were performed to assess the relationship between CACS and CAD.
CACS was higher in 81.1% of subjects diagnosed with CAD than in subjects without CAD. In multivariate logistic regression analysis, CACS determined by the Agatston score, volumetric score, and mass score was associated with CAD. In LASSO analysis, Agatston score (not the total Agatston score or other CACS) had the strongest correlation with CAD (β = 0.125). AUCs in the training set and the validation set were 0.811 and 0.789, respectively. Increased age, diabetes and hypertension correlated with higher Agatston score.
In addition to total CACS, CACS may be a novel diagnostic parameter for CAD, showing the calcium burden severity.
本研究旨在阐明最钙化冠状动脉中钙负荷的严重程度与冠状动脉疾病（CAD）之间的关系。
本研究纳入了 2011 年 3 月至 2020 年 7 月在中山大学孙逸仙纪念医院接受冠状动脉计算机断层扫描血管造影（CCTA）和有创冠状动脉造影（ICA）检查且在 30 天内完成两种检查的 2150 例患者。记录了三种冠状动脉钙评分（CACS），包括 Agatston 评分、体积评分和质量评分，以及其他临床变量。定义最钙化血管中最大与平均 CACS 的比值（CACS）为最钙化血管的 CACS/四大心外膜冠状动脉的平均 CACS。采用逻辑回归和最小绝对收缩和选择算子（LASSO）分析评估 CACS 与 CAD 之间的关系。
在诊断为 CAD 的患者中，81.1%的患者 CACS 较高。在多变量逻辑回归分析中，Agatston 评分、体积评分和质量评分所确定的 CACS 与 CAD 相关。在 LASSO 分析中，Agatston 评分（而非总 Agatston 评分或其他 CACS）与 CAD 相关性最强（β=0.125）。训练集和验证集中的 AUC 分别为 0.811 和 0.789。年龄增加、糖尿病和高血压与更高的 Agatston 评分相关。
除了总 CACS 之外，CACS 可能是 CAD 的一个新的诊断参数，可显示钙负荷的严重程度。
