Tan Yahang, Liu Chang, Chen Tao, Li Yina, Wang Chengjian, Zhao Jia, Zhou Jia
Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, 100069 Beijing, China.
Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 100069 Beijing, China.
Rev Cardiovasc Med. 2024 Mar 4;25(3):85. doi: 10.31083/j.rcm2503085. eCollection 2024 Mar.
For individuals with persistent stable chest pain (SCP) and a coronary artery calcium score (CACS) of 0, it might be challenging to establish the best risk assessment method for determining the individuals who will not benefit from further cardiovascular imaging testing (CIT). Thus, we investigated the CACS-weighted clinical likelihood (CACS-CL) model in SCP patients with a CACS of 0.
Thus, to assess SCP, we originally enrolled 14,232 individuals for CACS and coronary computed tomography angiography (CCTA) scans between January 2016 and January 2018. Finally, patients with a CACS of 0 were included and followed up until January 2022. According to the established CACS-CL cutoffs of 15% and 5%, the associations between coronary artery disease (CAD) and major adverse cardiovascular events (MACEs) in risk groups were evaluated, alongside the net reclassification improvement (NRI).
Of the 6689 patients with a CACS of 0, the prevalence of CAD increased significantly ( 0.0001) in patients with higher CACS-CL. However, there was no significant difference in the CAD distribution ( = 0.0637) between patients with CACS-CL 5% and 5-15%. The association between the CACS-CL = 15%-determined risk groups and the occurrence of MACEs was stronger than for a CACS-CL = 5% (adjusted hazard ratio (HR): 7.24 (95% CI: 1.93-16.42) versus 3.68 (95% CI: 1.50-8.26)). Compared with the cutoff for CACS-CL = 5%, the NRI was 10.61% when using a cutoff for CACS-CL = 15%.
Among patients with an SCP and CACS of 0, the CACS-CL model provided accurate predictions of CAD and MACEs. Compared to the cutoff for CACS-CL = 5%, the cutoff for CACS-CL = 15% seemed to be more effective and safer for deferring further CIT.
NCT04691037.
对于持续性稳定胸痛（SCP）且冠状动脉钙化评分（CACS）为0的个体，确定哪些个体无法从进一步的心血管成像检查（CIT）中获益的最佳风险评估方法可能具有挑战性。因此，我们在CACS为0的SCP患者中研究了CACS加权临床可能性（CACS-CL）模型。
为评估SCP，我们最初在2016年1月至2018年1月期间招募了14232名个体进行CACS和冠状动脉计算机断层扫描血管造影（CCTA）扫描。最后，纳入CACS为0的患者并随访至2022年1月。根据既定的CACS-CL临界值15%和5%，评估风险组中冠状动脉疾病（CAD）与主要不良心血管事件（MACE）之间的关联，以及净重新分类改善（NRI）。
在6689名CACS为0的患者中，CACS-CL较高的患者CAD患病率显著增加（P<0.0001）。然而，CACS-CL<5%和5%-15%的患者之间CAD分布无显著差异（P = 0.0637）。CACS-CL = 15%确定的风险组与MACE发生之间的关联强于CACS-CL = 5%（调整后危险比（HR）：7.24（95%CI：1.93 - 1十六条点四二）对3.68（95%CI：1.50 - 8.26））。与CACS-CL = 5%的临界值相比，使用CACS-CL = 15%的临界值时NRI为10.61%。
在SCP且CACS为0的患者中，CACS-CL模型对CAD和MACE提供了准确预测。与CACS-CL = 5%的临界值相比，CACS-CL = 15%的临界值在推迟进一步CIT方面似乎更有效且更安全。
NCT04691037。
