The association between left main coronary artery calcium and cardiovascular-specific and total mortality: The Coronary Artery Calcium Consortium
The association between left main coronary artery calcium and cardiovascular-specific and total mortality: The Coronary Artery Calcium Consortium
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DOI：
10.1016/j.atherosclerosis.2019.03.015
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发表时间：
2019-07-01
期刊：
影响因子：
5.3
通讯作者：
Blaha, Michael J.
中科院分区：
文献类型：
--
作者：
Lahti, Steven J.;Feldman, David, I;Blaha, Michael J.
背景和目的：冠状动脉左主干病变与较高的心肌梗死相关死亡率相关，然而，冠状动脉钙化(CAC)评分不能反映病变部位。方法：对28,147例CAC评分非零的无症状成人患者进行了病因特定的心血管和全因死亡率的研究。采用多元回归方法评估在调整临床危险因素和Agatston CAC评分后，是否存在和负担LMCAC可预测死亡率。结果：研究人群的平均年龄为58.3+/-10岁，CAC评分为301+/-631。21.7%的病例中Lm-CAC阳性。在312,398个病人年的随访中，观察到1,907人死亡。LM CAC与临床危险因素和总CAC的负担增加相关，并且独立地预测全因风险(HR 1.2[1.1，1.3])和心血管疾病死亡(HR 1.3[1.1，1.5])的风险增加。死亡风险与病变部位的CAC的比例成正比。在每100个Agatston单位的基础上，除了知道其他动脉的CAC外，LM CAC的死亡风险增加了6-9%。结论：在无症状的成年人中，左主干CAC的存在和高负担与心血管风险和总死亡率增加20%-30%独立相关，认为当存在LMCAC时，应常规地在CAC评分报告中予以注意。
Background and aims: Left main (LM) coronary artery disease is associated with greater myocardial infarction-related mortality, however, coronary artery calcium (CAC) scoring does not account for disease location. We explored whether LM CAC predicts excess mortality in asymptomatic adults.Methods: Cause-specific cardiovascular and all-cause mortality was studied in 28,147 asymptomatic patients with non-zero CAC scores in the CAC Consortium. Multivariate regression was performed to evaluate if the presence and burden of LM CAC predict mortality after adjustment for clinical risk factors and the Agatston CAC score. We further analyzed the per-unit hazard associated with LM CAC in comparison to CAC in other arteries.Results: The study population had mean age of 58.3 +/- 10 years and CAC score of 301 +/- 631. LM CAC was present in 21.7% of the cases. During 312,398 patient-years of follow-up, 1,907 deaths were observed. LM CAC was associated with an increased burden of clinical risk factors and total CAC, and was independently predictive of increased hazard for all-cause (HR 1.2 [1.1, 1.3]) and cardiovascular disease death (HR 1.3 [1.1, 1.5]). The hazard for death increased proportionate to the percentage of CAC localized to the LM. On a per-100 Agatston unit basis, LM CAC was associated with a 6-9% incremental hazard for death beyond knowledge of CAC in other arteries.Conclusions: The presence and high burden of left main CAC are independently associated with a 20-30% greater hazard for cardiovascular and total mortality in asymptomatic adults, arguing that LM CAC should be routinely noted in CAC score reports when present.