Coronary artery calcium scanning: Clinical paradigms for cardiac risk assessment and treatment
Coronary artery calcium scanning: Clinical paradigms for cardiac risk assessment and treatment
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DOI：
10.1016/j.ahj.2005.07.018
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发表时间：
2006-06-01
影响因子：
4.8
通讯作者：
Rumberger, John A.
中科院分区：
文献类型：
--
作者：
Hecht, Harvey S.;Budoff, Matthew J.;Rumberger, John A.
背景冠状动脉钙化扫描（CAC）的应用越来越广泛。用于无症状患者的心脏风险评估，特别是那些Framingham 10年风险为10%至20%的患者。医生对这项技术的认识及其适当的使用和限制对适当使用至关重要。方法结合已发表的主要文献、Framingham风险评分、美国国家胆固醇教育计划成人治疗计划III指南、美国心脏病学会/美国心脏协会运动测试和血管造影指南以及作者丰富的临床经验，建立临床模式。结果冠状动脉钙化扫描最适用于无症状人群，10年内发生心脏事件的风险在10% ~ 20%之间，可选择性地应用于高风险和低风险人群。在10%-20%的风险患者中，冠状动脉钙评分为>00或>，年龄和性别的第75百分位将中度高风险患者转化为高风险状态，并建议进行更积极的治疗；评分从11到100和< 75百分位与10%-20%的10年风险状态一致，评分从0到10和< 75百分位将患者转换为较低风险类别。如果计划对无症状患者进行压力测试，则应在冠状动脉钙扫描之前进行压力测试，并且仅在评分为bb0 - 400分时进行压力测试；在这些患者中，它应该优先于冠状动脉造影。结论冠状动脉钙化扫描是一种重要的风险评估工具，具有直接的临床应用价值；它在Framingham 10%-20%的10年风险人群中特别有用。
Background Coronary artery calcium (CAC) scanning is being increasingly used. for cardiac risk assessment in asymptornatic patients, particularly in those with a Framingham 10-year risk of 10% to 20%. Physician awareness of this technology and its appropriate uses and limitations is crucial to appropriate use.Methods With the goal of establishing clinical paradigms, this document integrates the results of key published articles, Framingham Risk Score, National Cholesterol Education Program Adult Treatment Plan III guidelines, American College of Cardiology/American Heart Association exercise testing and angiographic guidelines, and the authors' extensive clinical experience.Results Coronary artery calcium scanning is best used in the asymptomatic population with a 10% to 20% risk of cardiac events over 10 years, with selected application in higher and lower risk categories. In the 10%-20% risk patient, coronary artery calcium scores > 100 or > 75th percentile for age and sex transform the moderately high-risk patient to higher risk status with the attendant recommendation for more aggressive therapy; scores from 11 to 100 and < 75th percentile are consistent with the 10%-20% 10-year risk status and scores from 0 to 10 and < 75th percentile convert the patient to lesser risk categories. If stress testing is planned in the asymptornatic patient, it should be preceded by coronary artery calcium scanning and performed only for scores > 400; it should always precede coronary angiography in these patients.Conclusions Coronary artery calcium scanning is an important risk assessment tool with direct clinical applications; it is of particular utility in the Framingham 10%-20% 10-year risk population.