Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Nephrol Dial Transplant. 2023 May 4;38(5):1227-1239. doi: 10.1093/ndt/gfac252.
Vascular calcification is a known risk factor for cardiovascular events and mortality in patients with chronic kidney disease (CKD). However, since there is a lack of studies examining several arterial regions at a time, we aimed to evaluate the risk of major adverse cardiovascular events (MACE) and all-cause mortality according to calcium scores in five major arterial sites.
This was a prospective study of 580 patients from the Copenhagen CKD Cohort. Multidetector computed tomography of the coronary and carotid arteries, the thoracic aorta, the abdominal aorta and the iliac arteries was used to determine vascular calcification at baseline. Calcium scores were divided into categories: 0, 1-100, 101-400 and >400.
During the follow-up period of 4.1 years a total of 59 cardiovascular events and 64 all-cause deaths occurred. In Cox proportional hazards models adjusted for age, sex, estimated glomerular filtration rate, hypertension, diabetes mellitus, hypercholesterolemia and smoking, only the coronary and carotid arteries, and the thoracic aorta were independent predictors of the designated endpoints. When examining the potential of calcification in the five arterial sites for predicting MACE, the difference in C-statistic was also most pronounced in these three sites, at 0.21 [95% confidence interval (CI) 0.16%-0.26%, P < .001], 0.26 (95% CI 0.22%-0.3%, P < .001) and 0.20 (95% CI 0.16%-0.24%, P < .001), respectively. This trend also applied to all-cause mortality.
The overall results, including data on specificity, suggest that calcium scores of the coronary and carotid arteries have the most potential for identifying patients with CKD at high cardiovascular risk and for evaluating new therapies.
血管钙化是慢性肾脏病（CKD）患者心血管事件和死亡的已知危险因素。然而，由于缺乏同时检查多个动脉区域的研究，我们旨在根据五个主要动脉部位的钙评分评估主要不良心血管事件（MACE）和全因死亡率的风险。
这是一项对来自哥本哈根 CKD 队列的 580 名患者的前瞻性研究。使用多排螺旋 CT 对冠状动脉和颈动脉、胸主动脉、腹主动脉和髂动脉进行血管钙化检测。钙评分分为 0、1-100、101-400 和>400 四个等级。
在 4.1 年的随访期间，共发生 59 例心血管事件和 64 例全因死亡。在调整年龄、性别、估计肾小球滤过率、高血压、糖尿病、高胆固醇血症和吸烟因素的 Cox 比例风险模型中，只有冠状动脉和颈动脉以及胸主动脉是指定终点的独立预测因素。当检查五个动脉部位的钙化对预测 MACE 的潜在价值时，这三个部位的 C 统计差异也最为显著，分别为 0.21（95%置信区间 [CI]：0.16%-0.26%，P<0.001）、0.26（95% CI：0.22%-0.3%，P<0.001）和 0.20（95% CI：0.16%-0.24%，P<0.001）。这种趋势也适用于全因死亡率。
包括特异性在内的总体结果表明，冠状动脉和颈动脉的钙评分最有可能识别出 CKD 患者的心血管高风险，并评估新的治疗方法。
