Greif Martin, Lackermair Korbinian, Wessely Matthias, von Ziegler Franz, Becker Alexander
Department of Cardiology, Ludwig-Maximilians-University, 80539 Munich, Germany.
Rev Cardiovasc Med. 2024 Nov 8;25(11):398. doi: 10.31083/j.rcm2511398. eCollection 2024 Nov.
Coronary calcification is a well-established risk factor for cardiovascular events. This retrospective study sought to determine the predictive value of coronary calcification in a specific group of patients with chronic kidney disease.
We included 1094 asymptomatic patients (724 males, 370 females, age 62 ± 9.3 years) referred for cardiological examination. Patents were divided into two groups depending on their renal function. Coronary calcification was determined with a multi-slice computer tomography (CT) scanner. For quantification of coronary calcification the Agatston score was calculated. Over a mean follow up period of 6.2 ± 1.3 years we observed the rate of cardiovascular events (185 events, 61 myocardial infarctions, 103 revascularizations, 21 cardiac deaths).
The calcium score was significantly higher in patients with severe kidney disease (glomerular filtration rate (GFR) ≤30 mL/min/1.72 m) compared with those with normal to moderate reduced renal function (GFR ≥30 mL/min/1.72 m) (207 ± 190 .121 ± 169, ≤ 0.001). The event rate in patients with severe impaired renal function was significantly higher compared to patients with normal to moderate reduced renal function (20.6% . 14.8%, = 0.0001). The hazard ratio for cardiovascular events increased constantly with the calcium score in both groups. The hazard ratio in patients with severe kidney disease was significantly lower compared to patients in corresponding groups with regular to moderate reduced renal function (7.3 . 9.3, = 0.01). No cardiac events were observed in patients with a calcium score of 0.
We could demonstrate that risk prediction with the calcium score is possible in patients with severe chronic kidney disease even if the calcium score overestimates the risk for future cardiovascular events compared to patients with normal to moderate reduced renal function.
冠状动脉钙化是心血管事件公认的危险因素。这项回顾性研究旨在确定冠状动脉钙化在特定慢性肾病患者群体中的预测价值。
我们纳入了1094例因心脏检查而转诊的无症状患者（男性724例，女性370例，年龄62±9.3岁）。根据肾功能将患者分为两组。使用多层计算机断层扫描（CT）扫描仪确定冠状动脉钙化情况。为了量化冠状动脉钙化，计算了阿加斯顿评分。在平均6.2±1.3年的随访期内，我们观察了心血管事件的发生率（185例事件，61例心肌梗死，103例血运重建，21例心源性死亡）。
与肾功能正常至中度降低（肾小球滤过率（GFR）≥30 mL/min/1.72 m²）的患者相比，严重肾病（GFR≤30 mL/min/1.72 m²）患者的钙评分显著更高（207±190对121±169，P≤0.001）。肾功能严重受损患者的事件发生率显著高于肾功能正常至中度降低的患者（20.6%对14.8%，P = 0.0001）。两组中心血管事件的风险比均随钙评分不断增加。与肾功能正常至中度降低的相应组患者相比，严重肾病患者的风险比显著更低（7.3对9.3，P = 0.01）。钙评分为0的患者未观察到心脏事件。
我们可以证明，即使与肾功能正常至中度降低的患者相比，钙评分高估了未来心血管事件的风险，但在严重慢性肾病患者中使用钙评分进行风险预测仍是可行的。
