冠状动脉钙评分可预测稳定型胸痛患者的主要不良心血管事件。
Coronary Artery Calcium Score Predicts Major Adverse Cardiovascular Events in Stable Chest Pain.
机构信息
From the Department of Radiology (F.B., E.Z., A.E.N., R. Haase, S.F., M. Mohamed, M.R., V.W., M.E., M. Bosserdt, M.D.), Institute of Public Health (N.R.), Institute of Biometry and Clinical Epidemiology (K.N.), and Department of Cardiology and Angiology (H.D.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Radiology, University of Cagliari, Cagliari, Italy (L.S., R.C.); Heart and Vascular Center (M. Boussoussou, P.M.H., B.M., B.S., I.F.É.) and Department of Radiology, Medical Imaging Center (P.M.H.), Semmelweis University, Budapest, Hungary; Departments of Cardiology (K.F.K., P.E.S.) and Radiology (K.F.K., P.E.S.), Copenhagen University Hospital-Rigshospitalet and Department of Clinical Medicine (J.D.H.), Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Internal Medicine, Clinic of Cardiology (T.B., R. Hodas), and Department of Cardiology (R.A.), George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania; County Clinical Emergency Hospital Targu Mures, Targu Mures, Romania (T.B.); Department of Cardiology, Southeastern Health and Social Care Trust, Belfast, United Kingdom (P.D., C.O., S.K., S.R.); Departments of Cardiology (J.R.P., F.X.V., B.G.d.B.) and Radiology (H.C.C.), Hospital Universitario Vall d'Hebron, Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red, Madrid, Spain (J.R.P., F.X.V., B.G.d.B.); Departments of Cardiology (A.E.) and Radiology (L.Z.), Paul Stradins Clinical University Hospital, Riga, Latvia; University of Latvia, Riga, Latvia (A.E.); Departments of Cardiology (C.Š.) and Imaging Methods (V.S.), Motol University Hospital, Prague, Czech Republic; Department of Cardiology, Medical Academy (G.Š.), and Department of Radiology (A.J.), Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia (N.Č.A., F.A.); Department of Cardiology, Institute for Cardiovascular Diseases of Vojvodina, Novi Sad, Serbia (N.Č.A., F.A.); Departments of Radiology (M.G.) and Cardiology (M.W.), University of Leipzig Heart Centre, Leipzig, Germany; Departments of Radiology (J.D.D.) and Cardiology (D.C.), St. Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland (J.D.D.); Departments of Cardiology (I.D., A.R.) and Radiology (I.L.), Basurto Hospital, Bilbao, Spain; Departments of Cardiology (G.D.) and Radiology (E.T.), Aintree University Hospital, Liverpool, United Kingdom; Edge Hill University, Ormskirk, United Kingdom (G.D.); National Institute of Cardiology, Warsaw, Poland (C. Kępka, M.K.); Department of Cardiology, Internal Medicine Clinic, Clinical Hospital Center Zemun, and Faculty of Medicine, University of Belgrade, Belgrade, Serbia (R.V., A.N.N.); Department of Radiological, Oncological and Pathological Sciences (M. Francone) and Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences (M. Mancone), Sapienza University of Rome, Rome, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy (M. Francone); Departments of Cardiology (M.I.S.) and Radiology (D.K.), Provincial Specialist Hospital in Wroclaw, Wroclaw, Poland; Departments of Internal Medicine III (F.P.), Cardiology (F.P.), and Radiology (G.F.), Innsbruck Medical University, Innsbruck, Austria; Turku PET Centre (J.K.) and Heart Center (M.P.), Turku University Hospital and University of Turku, Turku, Finland; Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia-Espinho, Vila Nova de Gaia, Portugal (R.F., V.G.R.); Department of Cardiology, Alb Fils Kliniken, Göppingen, Germany (S.S., T.D.); School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom (C.B., C.D.); Golden Jubilee National Hospital, Clydebank, United Kingdom (C.B.); Department of Cardiology, Liverpool University Hospital NHS FT, Liverpool, United Kingdom (B.R., M. Fisher); Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (B.R., M. Fisher); European Clinical Research Infrastructure Network-European Research Infrastructure Consortium (ECRIN-ERIC), Paris, France (C. Kubiak); Department of Public Health, Section for Health Services Research, University of Copenhagen, Copenhagen, Denmark (K.S.H.); Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Munich, Germany (J.M.N.); Center of Advanced Research in Multimodality Cardiac Imaging, CardioMed Medical Center, Targu Mures, Romania (I.B., I.R.); Administrative Centre, Health Care District of Southwestern Finland, Turku, Finland (M.P.); Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom (M. Fisher); Department of Cardiology, Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark (C. Kragelund); Department of Cardiology, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark (J.D.H.); Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark (L.L.); DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany (M. Mohamed, M.D.); Department of Clinical Epidemiology and Applied Biostatistics, Universitätsklinikum Tübingen, Tübingen, Germany (L.M.S.H., P.M.); Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany (H.D., M.D.); Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Berlin, Germany (H.D.); Department of Cardiology, Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.); Berlin Institute of Health, Berlin, Germany (M.D.); and Berlin University Alliance, Berlin, Germany (M.D.).
出版信息
Radiology. 2024 Mar;310(3):e231557. doi: 10.1148/radiol.231557.
Background Coronary artery calcium (CAC) has prognostic value for major adverse cardiovascular events (MACE) in asymptomatic individuals, whereas its role in symptomatic patients is less clear. Purpose To assess the prognostic value of CAC scoring for MACE in participants with stable chest pain initially referred for invasive coronary angiography (ICA). Materials and Methods This prespecified subgroup analysis from the Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) trial, conducted between October 2015 and April 2019 across 26 centers in 16 countries, focused on adult patients with stable chest pain referred for ICA. Participants were randomly assigned to undergo either ICA or coronary CT. CAC scores from noncontrast CT scans were categorized into low, intermediate, and high groups based on scores of 0, 1-399, and 400 or higher, respectively. The end point of the study was the occurrence of MACE (myocardial infarction, stroke, and cardiovascular death) over a median 3.5-year follow-up, analyzed using Cox proportional hazard regression tests. Results The study involved 1749 participants (mean age, 60 years ± 10 [SD]; 992 female). The prevalence of obstructive coronary artery disease (CAD) at CT angiography rose from 4.1% (95% CI: 2.8, 5.8) in the CAC score 0 group to 76.1% (95% CI: 70.3, 81.2) in the CAC score 400 or higher group. Revascularization rates increased from 1.7% to 46.2% across the same groups ( < .001). The CAC score 0 group had a lower MACE risk (0.5%; HR, 0.08 [95% CI: 0.02, 0.30]; < .001), as did the 1-399 CAC score group (1.9%; HR, 0.27 [95% CI: 0.13, 0.59]; = .001), compared with the 400 or higher CAC score group (6.8%). No significant difference in MACE between sexes was observed ( = .68). Conclusion In participants with stable chest pain initially referred for ICA, a CAC score of 0 showed very low risk of MACE, and higher CAC scores showed increasing risk of obstructive CAD, revascularization, and MACE at follow-up. Clinical trial registration no. NCT02400229 © RSNA, 2024 See also the editorial by Hanneman and Gulsin in this issue.
背景 冠状动脉钙化（CAC）对无症状个体的主要不良心血管事件（MACE）具有预后价值，但其在有症状患者中的作用尚不清楚。目的 评估 CAC 评分对初始接受有创冠状动脉造影（ICA）检查的稳定型胸痛患者发生 MACE 的预测价值。材料与方法 该研究是来自诊断成像策略在稳定型胸痛和中等风险冠心病患者（DISCHARGE）试验的预设亚组分析，于 2015 年 10 月至 2019 年 4 月在 16 个国家的 26 个中心进行，纳入了稳定型胸痛并接受 ICA 检查的成年患者。参与者被随机分配接受 ICA 或冠状动脉 CT 检查。非对比 CT 扫描的 CAC 评分根据评分分为低、中、高 3 组，分别为 0、1-399 和 400 或更高。研究的终点是中位 3.5 年随访期间发生 MACE（心肌梗死、卒中和心血管死亡），使用 Cox 比例风险回归检验进行分析。结果 研究纳入 1749 名参与者（平均年龄 60 岁±10[SD]；992 名女性）。CT 血管造影显示阻塞性冠状动脉疾病（CAD）的患病率从 CAC 评分 0 组的 4.1%（95%CI：2.8，5.8）上升至 CAC 评分 400 或更高组的 76.1%（95%CI：70.3，81.2）。血管重建率也从 CAC 评分 0 组的 1.7%上升至 CAC 评分 400 或更高组的 46.2%（均<0.001）。CAC 评分 0 组的 MACE 风险较低（0.5%；HR，0.08[95%CI：0.02，0.30]；<0.001），1-399 CAC 评分组也较低（1.9%；HR，0.27[95%CI：0.13，0.59]；=0.001），而 CAC 评分 400 或更高组则较高（6.8%）。未观察到不同性别之间 MACE 存在显著差异（=0.68）。结论 在初始接受 ICA 检查的稳定型胸痛患者中，CAC 评分为 0 提示 MACE 的风险非常低，而 CAC 评分较高则提示阻塞性 CAD、血管重建和随访期间 MACE 的风险增加。临床试验注册号 NCT02400229 © RSNA，2024 请参阅本期 Hanneman 和 Gulsin 的社论。
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