Viladés-Medel David, Dégano Irene R, Subirana Isaac, Descalzo Martin, Padilla Mireia, Mundet Xavier, Carreras Costa Francesc, Alomar Serrallach Xavier, Camps Anna, Elosua Roberto, Marrugat Jaume, Leta Petracca Rubén
Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona (UAB), 08193 Barcelona, Spain.
CIBER de Enfermedades Cardio-Vasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.
J Clin Med. 2022 Jan 21;11(3):533. doi: 10.3390/jcm11030533.
Accurate identification of individuals at high coronary risk would reduce acute coronary syndrome incidence and morbi-mortality. We analyzed the effect on coronary risk prediction of adding coronary artery calcification (CAC) and Segment Involvement Score (SIS) to cardiovascular risk factors. This was a prospective cohort study of asymptomatic patients recruited between 2013-2017. All participants underwent a coronary computed tomography angiography to determine CAC and SIS. The cohort was followed-up for a composite endpoint of myocardial infarction, coronary angiography and/or revascularization (median = five years). Discrimination and reclassification of the REGICOR function with CAC/SIS were examined with the Sommer's D index and with the Net reclassification index (NRI). Nine of the 251 individuals included had an event. Of the included participants, 94 had a CAC = 0 and 85 a SIS = 0, none of them had an event. The addition of SIS or of SIS and CAC to the REGICOR risk function significantly increased the discrimination capacity from 0.74 to 0.89. Reclassification improved significantly when SIS or both scores were included. CAC and SIS were associated with five-year coronary event incidence, independently of cardiovascular risk factors. Discrimination and reclassification of the REGICOR risk function were significantly improved by both indexes, but SIS overrode the effect of CAC.
准确识别高冠状动脉风险个体可降低急性冠状动脉综合征的发病率和病死/死亡率。我们分析了将冠状动脉钙化（CAC）和节段累及评分（SIS）纳入心血管危险因素对冠状动脉风险预测的影响。这是一项对2013年至2017年间招募的无症状患者进行的前瞻性队列研究。所有参与者均接受冠状动脉计算机断层扫描血管造影以确定CAC和SIS。对该队列进行随访，观察心肌梗死、冠状动脉造影和/或血运重建的复合终点（中位数 = 5年）。使用索末尔D指数和净重新分类指数（NRI）检查REGICOR功能结合CAC/SIS后的鉴别能力和重新分类情况。纳入的251名个体中有9人发生了事件。在纳入的参与者中，94人CAC = 0，85人SIS = 0，他们均未发生事件。将SIS或SIS与CAC纳入REGICOR风险函数后，鉴别能力从0.74显著提高到0.89。纳入SIS或两个评分时，重新分类显著改善。CAC和SIS与5年冠状动脉事件发生率相关，独立于心血管危险因素。两个指数均显著改善了REGICOR风险函数的鉴别能力和重新分类情况，但SIS的作用超过了CAC。
