Frey Simon M, Huré Gabrielle, Leibfarth Jan-Philipp, Thommen Kathrin, Amrein Melissa, Rumora Klara, Schäfer Ibrahim, Caobelli Federico, Wild Damian, Haaf Philip, Mueller Christian E, Zellweger Michael J
Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
Front Cardiovasc Med. 2024 Sep 23;11:1467916. doi: 10.3389/fcvm.2024.1467916. eCollection 2024.
Despite clinical suspicion, most non-invasive ischemia tests for coronary artery disease (CAD) reveal unremarkable results. Patients with a coronary artery calcium score (CACS) of zero rarely have an abnormal positron emission tomography (PET) and could be deferred from further testing. However, most patients have some extent of coronary calcification.
CACS percentiles could be useful to exclude abnormal perfusion in patients with CACS >0, but data from patients with Rb PET are lacking. The aim of this study was to assess the diagnostic utility of CACS percentiles in comparison to zero calcium and absolute CACS classes.
Consecutive patients with suspected CAD ( = 1,792) referred for Rb PET were included and analyzed for abnormal PET (SSS ≥4) and relevant ischemia (>10% myocardium). Test characteristics were calculated.
The mean age was 65 ± 11 years, 43% were female, and typical angina was reported in 21%. Abnormal PET/relevant ischemia (>10%) were observed in 19.8%/9.3%. Overall, the sensitivity/negative predictive value (NPV) of a <25th percentile CACS to rule out abnormal PET and relevant ischemia were 93.0%/95.7% and 98.2%/99.5%, respectively. The sensitivity/NPV of CACS 1-9 to rule out abnormal PET and relevant ischemia were 96.0%/91.8% and 97.6%/97.6%, respectively. Except for patients <50 years old, sensitivity for abnormal PET was >90.9% in all age groups.
In patients >50 years, the <25th percentile and CACS 1-9 had good test characteristics to rule out abnormal PET and relevant ischemia (>10%). They could be used to extend the scope of application of CACS 0 by 8%-10% to 32%-34% overall of patients who could be deferred from further testing.
尽管临床上存在怀疑，但大多数用于冠状动脉疾病（CAD）的非侵入性缺血检测结果并不显著。冠状动脉钙化积分（CACS）为零的患者很少有异常的正电子发射断层扫描（PET）结果，可免于进一步检查。然而，大多数患者存在一定程度的冠状动脉钙化。
CACS百分位数可能有助于排除CACS>0患者的异常灌注，但缺乏使用铷（Rb）PET患者的数据。本研究的目的是评估CACS百分位数与零钙化及绝对CACS类别相比的诊断效用。
纳入连续接受铷PET检查的疑似CAD患者（n = 1792），分析其PET异常（SSS≥4）及相关缺血（>10%心肌）情况，并计算检测特征。
患者平均年龄为65±11岁，43%为女性，21%报告有典型心绞痛。19.8%/9.3%的患者观察到PET异常/相关缺血（>10%）。总体而言，CACS<第25百分位数排除PET异常和相关缺血的敏感性/阴性预测值（NPV）分别为93.0%/95.7%和98.2%/99.5%。CACS 1 - 9排除PET异常和相关缺血的敏感性/NPV分别为96.0%/91.8%和97.6%/97.6%。除<50岁患者外，各年龄组PET异常的敏感性均>90.9%。
在>50岁的患者中，<第25百分位数和CACS 1 - 9在排除PET异常和相关缺血（>10%）方面具有良好的检测特征。它们可用于将CACS 0的适用范围总体扩大8% - 10%至32% - 34%，使这些患者可免于进一步检查。
