Tummala Ramyashree, Han Donghee, Friedman John, Hayes Sean, Thomson Louise, Gransar Heidi, Slomka Piotr, Rozanski Alan, Dey Damini, Berman Daniel
Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Division of Cardiology, Mount Sinai Morningside Hospital, New York, New York.
Am J Prev Cardiol. 2022 Sep 27;12:100423. doi: 10.1016/j.ajpc.2022.100423. eCollection 2022 Dec.
Coronary artery calcium score (CAC) is a validated tool to predict and reclassify cardiovascular risk. Additional metrics such as regional distribution and extent of CAC over Agatston CAC score may allow further risk stratification. In this study, we evaluate the prognostic significance of proximal CAC involvement in asymptomatic population from the prospective EISNER (Early-Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) registry, focusing on patients with mild CAC (score 1-99).
This study included a total of 2,047 adult asymptomatic subject who underwent baseline CAC scan and 14-year follow-up for MACE, defined as myocardial infarction, late revascularization, or cardiac death. Proximal involvement was defined as presence of CAC in the LM, proximal LAD, LCX or RCA. CAC was categorized as 0, 1-99, and ≥100.
1,090 (53.2%) subjects had no CAC, 576 (28.1%) had CAC 1-99, and 381 (18.7%) had CAC ≥100. Proximal involvement was seen in 67.2% of subjects with CAC 1-99 and 97.3% of subjects with CAC ≥100. In the CAC 1-99 category, the presence of proximal CAC was associated with increased MACE risk after adjustment for CAC score, CAC extent and conventional risk factors compared to those without proximal CAC (HR: 2.84 95% CI: 1.29-6.25, p=0.009).
In asymptomatic subjects with CAC scores of 1-99, the presence and extent of proximal CAC plaques provides strong independent prognostic information in predicting MACE.
冠状动脉钙化积分（CAC）是一种经过验证的用于预测和重新分类心血管风险的工具。除了阿加西（Agatston）CAC积分外，诸如区域分布和CAC范围等其他指标可能有助于进一步进行风险分层。在本研究中，我们从前瞻性EISNER（通过无创成像研究早期识别亚临床动脉粥样硬化）注册研究中评估近端CAC累及在无症状人群中的预后意义，重点关注轻度CAC（积分1 - 99）的患者。
本研究共纳入2047名成年无症状受试者，他们接受了基线CAC扫描并进行了长达14年的主要不良心血管事件（MACE，定义为心肌梗死、晚期血运重建或心源性死亡）随访。近端累及定义为左主干（LM）、近端左前降支（LAD）、左旋支（LCX）或右冠状动脉（RCA）存在CAC。CAC分为0、1 - 99和≥100。
1090名（53.2%）受试者无CAC，576名（28.1%）受试者的CAC为1 - 99，381名（18.7%）受试者 的CAC≥100。在CAC为1 - 99的受试者中，67.2%存在近端累及；在CAC≥100的受试者中，97.3%存在近端累及。在CAC为1 - 99的类别中，与无近端CAC的受试者相比，在校正了CAC积分、CAC范围和传统危险因素后，近端CAC的存在与MACE风险增加相关（风险比：2.84，95%置信区间：1.29 - 6.25，p = 0.009）。
在CAC积分为1 - 99的无症状受试者中，近端CAC斑块的存在和范围在预测MACE方面提供了强有力的独立预后信息。
