Groen Roos A, Jukema J Wouter, van Dijkman Paul R M, Timmermans Patrick T, Bax Jeroen J, Lamb Hildo J, de Graaf Michiel A
Department of Cardiology, Leiden University Medical Center, The Netherlands.
Department of Cardiology, Leiden University Medical Center, The Netherlands; The Netherlands Heart Institute, Utrecht, The Netherlands.
Am J Cardiol. 2023 Dec 1;208:92-100. doi: 10.1016/j.amjcard.2023.08.186. Epub 2023 Oct 10.
Given current pretest probability (PTP) estimations tend to overestimate patients' risk for obstructive coronary artery disease, evaluation of patients' coronary artery calcium (CAC) is more precise. The value of CAC assessment with the Agatston score on cardiac computed tomography (CT) for risk estimation has been well indicated in patients with stable chest pain. CAC can be equally well assessed on routine non-gated chest CT, which is often available. This study aims to determine the clinical applicability of CAC assessment on non-gated CT in patients with stable chest pain compared with the classic Agatston score on gated CT. Consecutive patients referred for evaluation of the Agatston score, who had a previously performed non-gated chest CT for evaluation of noncardiac diseases, were included. CAC on non-gated CT was ordinally scored. Subsequently, patients were stratified according to CAC severity and PTP. The agreement and correlation between the classic Agatston score and CAC on non-gated CT were evaluated. The discriminative power for risk reclassification of both CAC assessment methods was assessed. Invasive coronary angiography was used as the gold standard, when available. A total of 140 patients aged between 30 and 88 years were included. The agreement between ordinally scored CAC and the Agatston score was excellent (κ = 0.82) and the correlation strong (r = 0.94). Most patients (80%) with an intermediate PTP had no or mild CAC on non-gated CT. They were reclassified at low risk with 100% accuracy compared with invasive coronary angiography. Similarly, 86% of patients had an Agatston score <300. These patients were reclassified with 98% accuracy. In patients with high PTP, the accuracy remained substantial and comparable, 94% and 89%, respectively. In conclusion, we believe this is the first study to assess the clinical applicability of CAC on non-gated CT in patients with stable chest pain, compared with the classic Agatston score. The agreement between methods was excellent and the correlation strong. Furthermore, CAC assessment on non-gated CT could reclassify patients' risk for obstructive coronary artery disease as accurately as could the classic Agatston score.
鉴于当前的验前概率（PTP）估计往往高估患者患阻塞性冠状动脉疾病的风险，对患者的冠状动脉钙化（CAC）进行评估更为精确。在稳定性胸痛患者中，心脏计算机断层扫描（CT）上使用阿加斯顿评分进行CAC评估以估计风险的价值已得到充分证实。在常规非门控胸部CT上也可以同样良好地评估CAC，而这种CT通常是可获得的。本研究旨在确定与门控CT上的经典阿加斯顿评分相比，非门控CT上CAC评估在稳定性胸痛患者中的临床适用性。纳入了连续接受阿加斯顿评分评估且之前已进行非门控胸部CT以评估非心脏疾病的患者。对非门控CT上的CAC进行序数评分。随后，根据CAC严重程度和PTP对患者进行分层。评估经典阿加斯顿评分与非门控CT上的CAC之间的一致性和相关性。评估两种CAC评估方法对风险重新分类的鉴别能力。如有条件，将有创冠状动脉造影用作金标准。共纳入140例年龄在30至88岁之间的患者。序数评分的CAC与阿加斯顿评分之间的一致性极佳（κ = 0.82），相关性很强（r = 0.94）。大多数（80%）PTP为中等的患者在非门控CT上没有或仅有轻度CAC。与有创冠状动脉造影相比，他们被重新分类为低风险，准确率为100%。同样，86%的患者阿加斯顿评分<300。这些患者被重新分类的准确率为98%。在PTP高的患者中，准确率仍然很高且相当，分别为94%和89%。总之，我们认为这是第一项评估与经典阿加斯顿评分相比，非门控CT上CAC在稳定性胸痛患者中的临床适用性的研究。两种方法之间的一致性极佳，相关性很强。此外，非门控CT上的CAC评估对阻塞性冠状动脉疾病患者风险的重新分类与经典阿加斯顿评分一样准确。
