Graby J, Soto-Hernaez J, Murphy D, Oldman J L A F, Burnett T A, Charters P F P, Barrishi A, Thanaraaj T, Masterman B J, Khavandi A, Rodrigues J C L
Department of Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK; Department for Health, University of Bath, Claverton Down, Bath BA2 7AY, UK.
Faculty of Health Sciences, University of Bristol, Bristol BS8 1TH, UK.
Clin Radiol. 2023 Jun;78(6):412-420. doi: 10.1016/j.crad.2023.02.007. Epub 2023 Mar 1.
Guidelines have recommended reporting coronary artery calcification (CAC) if present on chest CT imaging regardless of indication. This study assessed CAC prevalence, prognosis and the potential clinical impact of its reporting.
We performed a single-centre retrospective analysis (January-December 2015) of 1400 chest CTs (200 consecutive within each age group: <40, 40-49, 50-59, 60-69, 70-79, 80-89, ≥90). CTs were re-reviewed for CAC presence and severity and excluded if prior coronary intervention. Comorbidities, statin prescription and clinical outcomes (myocardial infarction [MI], stroke, all-cause mortality) were recorded. The impact of reporting CAC was assessed against pre-existing statin prescriptions.
1343 patients were included (mean age 63±20 years, 56% female). Inter- and intra-observer variability for CAC presence at re-review was almost perfect (κ 0.89, p < 0.001; κ 0.90, p < 0.001) and for CAC grading was substantial and almost perfect (κ 0.68, p < 0.001; κ 0.91, p < 0.001). CAC was observed in 729/1343 (54%), more frequently in males (p < 0.001) and rising age (p < 0.001). A high proportion of patients with CAC in all age groups had no prior statin prescription (range: 42% [80-89] to 100% [<40]). The 'number needed to report' CAC presence to potentially impact management across all ages was 2. 689 (51%) patients died (median follow-up 74-months). CAC presence was associated with risk of MI, stroke and all-cause mortality (p < 0.001). After adjusting for confounders, severe calcification predicted risk of all-cause mortality (HR 1.8 [1.2-2.5], p = 0.002).
Grading of CAC was reproducible, and although prevalence rose with age, prognostic and treatment implications were maintained in all ages.
指南建议，无论出于何种指征，胸部CT成像显示冠状动脉钙化（CAC）时均应报告。本研究评估了CAC的患病率、预后及其报告的潜在临床影响。
我们对1400例胸部CT（每个年龄组连续200例：<40岁、40 - 49岁、50 - 59岁、60 - 69岁、70 - 79岁、80 - 89岁、≥90岁）进行了单中心回顾性分析（2015年1月至12月）。重新检查CT以确定是否存在CAC及其严重程度，若有冠状动脉介入史则排除。记录合并症、他汀类药物处方及临床结局（心肌梗死[MI]、中风、全因死亡率）。根据现有的他汀类药物处方评估报告CAC的影响。
纳入1343例患者（平均年龄63±20岁，56%为女性）。重新检查时观察者间和观察者内对CAC存在情况的一致性几乎完美（κ = 0.89，p < 0.001；κ = 0.90，p < 0.001），对CAC分级的一致性较高且几乎完美（κ = 0.68，p < 0.001；κ = 0.91，p < 0.001）。1343例中有729例（54%）观察到CAC存在，男性更常见（p < 0.001）且随年龄增长而增加（p < 0.001）。所有年龄组中，很大一部分CAC患者此前未服用他汀类药物（范围：42%[80 - 89岁]至100%[<40岁]）。在所有年龄组中，报告CAC存在以潜在影响治疗的“需报告数”为2。689例（51%）患者死亡（中位随访74个月）。CAC的存在与MI、中风和全因死亡风险相关（p < 0.001）。调整混杂因素后，严重钙化可预测全因死亡风险（HR 1.8[1.2 - 2.5]，p = 0.002）。
CAC分级具有可重复性，尽管患病率随年龄增长，但在所有年龄组中其预后和治疗意义均存在。
