Prognostic Value of Coronary CT Angiography and Calcium Score for Major Adverse Cardiac Events in Outpatients
Prognostic Value of Coronary CT Angiography and Calcium Score for Major Adverse Cardiac Events in Outpatients
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DOI：
10.1016/j.jcmg.2012.06.006
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发表时间：
2012-10-01
影响因子：
14
通讯作者：
Budoff, Matthew J.
中科院分区：
文献类型：
--
作者：
Hou, Zhi-hui;Lu, Bin;Budoff, Matthew J.
目的探讨冠状动脉钙化积分(CACS)和冠状动脉CT血管成像(CTA)对严重不良心脏事件(MACE)的预后价值。很少有研究利用冠状动脉CTA的丰富信息来预测未来的临床结果，并将CACs与冠状动脉CTA进行比较。方法我们对5007例怀疑患有冠心病(CAD)并接受心脏CTA的门诊患者进行了随访。心脏CT评估CACs和冠状动脉CTA斑块的范围、位置、狭窄程度和组成。终点是MACE，定义为复合性心脏性死亡、非致命性心肌梗死或冠状动脉血运重建。结果4425名患者(88.4%)完成了随访期，中位随访期为1081天。在随访期结束时，363例(8.2%)患者发生了MACE。3年内发生MACE的累积概率在CT层面上增加：CACS(0，2.1%；CACS1~100%，12.9%；CACS101~400%，16.3%；CACS400，33.8%；对数等级p<；0.001)；对于冠状动脉CTA(无斑块0.8%，非梗阻性疾病3.7%，1支病变27.6%，2支病变35.5%，3支病变57.7%；对数等级p<；0.001)；斑块特征(钙化斑块占5.5%，非钙化斑块占22.7%，混合斑块占37.7%；对数等级p<；0.001)。受试者-操作特征曲线下面积显示CACs和冠状动脉CTA预测MACE的增量值：临床危险因素：0.71，加入CACs后提高到0.82，再加上冠状动脉CTA(P<；0.001)进一步提高到0.93。结论CACs和冠状动脉CTA对MACE有预测价值，且较常规危险因素有增量价值，且冠状动脉CTA优于CACs。心脏CT似乎是一种有希望的无创检查方法，具有显著的预后价值。(J Am Coll心脏ol IMG 2012；5：990-9)(C)2012，美国心脏病学会基金会
OBJECTIVES This study sought to evaluate the prognostic value of coronary artery calcium score (CACS) and coronary computed tomography angiography (CTA) for major adverse cardiac events (MACE).BACKGROUND The prognostic value of CACS has been well described. Few studies use the rich information of coronary CTA to predict future clinical outcomes and compare CACS with coronary CTA.METHODS We followed up 5,007 outpatients who were suspected of having coronary artery disease (CAD) and who underwent cardiac CTA. Cardiac CT was assessed for CACS and the extent, the location, the stenosis severity, and the composition of the plaque in coronary CTA. The endpoint was MACE, defined as composite cardiac death, nonfatal myocardial infarction, or coronary revascularization.RESULTS Follow-up was completed in 4,425 patients (88.4%), with a median follow-up period of 1,081 days. At the end of the follow-up period, 363 (8.2%) patients had experienced MACE. Cumulative probability of 3-year MACE increased across CT strata for CACS (CACS 0, 2.1%; CACS 1 to 100, 12.9%; CACS 101 to 400, 16.3%; and CACS >400, 33.8%; log-rank p < 0.001); for coronary CTA (no plaque 0.8%, nonobstructive disease 3.7%, 1-vessel disease 27.6%, 2-vessel disease 35.5%, and 3-vessel disease 57.7%; log-rank p < 0.001); and for characteristics of the plaques (5.5% for calcified plaque, 22.7% for noncalcified plaque, and 37.7% for mixed plaque; log-rank p < 0.001). The area under the receiver-operating characteristic curves showed the incremental value of CACS and coronary CTA for predicting MACE: 0.71 for clinical risk factors, which improved to 0.82 by adding CACS and further improved to 0.93 by adding coronary CTA (both p < 0.001).CONCLUSIONS The CACS and coronary CTA findings have prognostic value and have incremental value over routine risk factors for MACE, and coronary CTA is superior to CACS. Cardiac CT seems to be a promising noninvasive modality with significant prognostic value. (J Am Coll Cardiol Img 2012;5:990-9) (C) 2012 by the American College of Cardiology Foundation