Playford Emma, Stewart Simon, Hoyne Gerard, Strange Geoff, Dwivedi Girish, Hamilton-Craig Christian, Figtree Gemma, Playford David
The University of Notre Dame Australia, Fremantle, WA, Australia.
Institute for Respiratory Health, QEII Medical Centre, Nedlands, WA, Australia.
Am Heart J Plus. 2024 Dec 6;49:100493. doi: 10.1016/j.ahjo.2024.100493. eCollection 2025 Jan.
There is limited data showing the predictive accuracy of traditional cardiovascular risk scores (CVRS) to predict asymptomatic coronary artery disease (CAD) determined by coronary computed tomography angiography (CCTA).
Asymptomatic individuals without known CAD undergoing a screening CCTA and sufficient data to calculate their CVRS, were extracted retrospectively. Atherosclerosis was extracted using natural language processing of the CCTA report, including the coronary artery calcium score (CACS) and the extent and severity of CAD. Absence of atherosclerosis was defined as both zero plaque and zero CACS, and atherosclerosis was defined as low, moderate, or extensive by location and extent of plaque-burden. CVRS was categorized as high (>15 %), moderate (10-15 %), low (1-9 %) and "zero" (<1 %) risk.
828 individuals (median age 58.6, IQR = 52.0, 65.3 years, 57 % male) met inclusion criteria, and a zero, low, moderate, and high CVRS was identified in 13, 483, 113 and 219 individuals (8 %, 49 %, 74 %, 66 % male), respectively. Predominantly low plaque-burden atherosclerosis was detected in 548 scans (67 % male). However, of the 137 males and 68 females with extensive atherosclerosis, 47 (34 %) and 38 (56 %) respectively had low CVRS classification. Overall, 23 % of males and 31 % of females had CAD predicted by CVRS (Monte Carlo: females, = 0.024; males, < 0.001), but there was little to no agreement between CVRS and atherosclerosis burden (Cohen's kappa: males, = 0.149; females, = 0.096).
In asymptomatic individuals without known CAD, a low CVRS does not exclude extensive CAD. Newer tools incorporating additional markers may be helpful in risk prediction in such individuals.
关于传统心血管风险评分（CVRS）预测冠状动脉计算机断层扫描血管造影（CCTA）所确定的无症状冠状动脉疾病（CAD）的预测准确性的数据有限。
回顾性提取无症状且无已知CAD的个体，这些个体接受了筛查CCTA并拥有足够的数据来计算其CVRS。使用CCTA报告的自然语言处理提取动脉粥样硬化情况，包括冠状动脉钙化评分（CACS）以及CAD的范围和严重程度。无动脉粥样硬化定义为斑块和CACS均为零，动脉粥样硬化根据斑块负荷的位置和范围分为低、中、广泛。CVRS分为高风险（>15%）、中风险（10 - 15%）、低风险（1 - 9%）和“零”风险（<1%）。
828名个体（中位年龄58.6岁，IQR = 52.0，65.3岁，57%为男性）符合纳入标准，CVRS为零、低、中、高风险的个体分别有13、483、113和219名（男性分别占8%、49%、74%、66%）。在548次扫描中检测到主要为低斑块负荷的动脉粥样硬化（男性占67%）。然而，在137名男性和68名女性广泛动脉粥样硬化患者中，分别有47名（34%）和38名（56%）的CVRS分类为低风险。总体而言，CVRS预测CAD的男性为23%，女性为31%（蒙特卡洛法：女性，P = 0.024；男性，P < 0.001），但CVRS与动脉粥样硬化负担之间几乎没有一致性（科恩kappa系数：男性，κ = 0.149；女性，κ = 0.096）。
在无症状且无已知CAD的个体中，低CVRS并不能排除广泛CAD。纳入额外标志物的新工具可能有助于对此类个体进行风险预测。
