联合解剖学和生物化学标志物检测和危险分层的冠状动脉疾病。
Combining anatomical and biochemical markers in the detection and risk stratification of coronary artery disease.
机构信息
Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031, Basel, Switzerland.
Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
出版信息
Eur Heart J Cardiovasc Imaging. 2024 Aug 26;25(9):1197-1205. doi: 10.1093/ehjci/jeae093.
AIMS
We aimed to test the hypothesis if combining coronary artery calcium score (Ca-score) as a quantitative anatomical marker of coronary atherosclerosis with high-sensitivity cardiac troponin as a quantitative biochemical marker of myocardial injury provided incremental value in the detection of functionally relevant coronary artery disease (fCAD) and risk stratification.
METHODS AND RESULTS
Consecutive patients undergoing myocardial perfusion single-photon emission computed tomography (MPS) without prior CAD were enrolled. The diagnosis of fCAD was based on the presence of ischaemia on MPS and coronary angiography; fCAD was centrally adjudicated in the diagnostic and prognostic domain. Diagnostic accuracy was evaluated using the area under the receiver-operating characteristic curve (AUC). The composite of cardiovascular death and non-fatal acute myocardial infarction (AMI) within 730 days was the primary prognostic endpoint. Among 1715 patients eligible for the diagnostic analysis, 399 patients had fCAD. The combination of Ca-score and high-sensitivity cardiac troponin T (hs-cTnT) had good diagnostic accuracy for the diagnosis of fCAD (AUC 0.79, 95% confidence interval (CI) 0.77-0.81), but no incremental value compared with the Ca-score alone (AUC 0.79, 95% CI 0.77-0.81, P = 0.965). Similar results were observed using high-sensitivity cardiac troponin I (AUC 0.80, 95% CI 0.77-0.82) instead of hs-cTnT. Among 1709 patients (99.7%) with available follow-up, 59 patients (3.5%) suffered the composite primary prognostic endpoint (non-fatal AMI, n = 34; CV death, n = 28). Both Ca-score and hs-cTnT had independent prognostic value. Increased risk was restricted to patients with elevation in both markers.
CONCLUSION
The combination of the Ca-score with hs-cTnT increases the prognostic accuracy for future events but does not provide incremental value vs. the Ca-score alone for the diagnosis of fCAD.
STUDY REGISTRATION
Clinical trial registration: NCT00470587.
目的
我们旨在验证一个假设，如果将冠状动脉钙评分（Ca-score）作为冠状动脉粥样硬化的定量解剖学标志物，与高敏心肌肌钙蛋白作为心肌损伤的定量生化标志物相结合，是否能提高功能性相关冠状动脉疾病（fCAD）的检出率和风险分层能力。
方法和结果
连续纳入了接受心肌灌注单光子发射计算机断层扫描（MPS）且无 CAD 病史的患者。fCAD 的诊断基于 MPS 和冠状动脉造影的缺血表现；fCAD 在诊断和预后领域由中心裁决。使用接受者操作特征曲线下面积（AUC）评估诊断准确性。730 天内心血管死亡和非致死性急性心肌梗死（AMI）的复合终点是主要预后终点。在 1715 名符合诊断分析条件的患者中，有 399 名患者患有 fCAD。Ca-score 和高敏心肌肌钙蛋白 T（hs-cTnT）联合具有良好的 fCAD 诊断准确性（AUC 为 0.79，95%置信区间[CI]为 0.77-0.81），但与单独使用 Ca-score 相比没有增量价值（AUC 为 0.79，95%CI 为 0.77-0.81，P = 0.965）。使用高敏心肌肌钙蛋白 I（AUC 为 0.80，95%CI 为 0.77-0.82）代替 hs-cTnT 也得到了相似的结果。在 1709 名（99.7%）有随访资料的患者中，有 59 名（3.5%）发生了主要复合预后终点（非致死性 AMI，n = 34；心血管死亡，n = 28）。Ca-score 和 hs-cTnT 均具有独立的预后价值。风险增加仅限于两个标志物均升高的患者。
结论
Ca-score 与 hs-cTnT 联合使用可提高未来事件的预后准确性，但与单独使用 Ca-score 相比，在诊断 fCAD 方面没有额外价值。
研究注册
临床试验注册：NCT00470587。
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