Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals
Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals
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DOI：
10.1001/jama.291.2.210
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发表时间：
2004-01-14
影响因子：
120.7
通讯作者：
Detrano, RC
中科院分区：
文献类型：
--
作者：
Greenland, P;LaBree, L;Detrano, RC
指南建议所有成年人接受冠心病（CHD）风险评估，以指导预防性治疗强度。虽然经常推荐使用Framingham风险评分（FRS），但也有人建议通过冠状动脉钙评分（CACS）等其他测试来改善风险评估。目的探讨CACS评估联合FIRS对无症状成人的预后信息是否优于单独使用任何一种方法，以及联合方法是否能更准确地指导CHID危险因素患者的一级预防策略。设计、环境和参与者：基于人群的前瞻性观察研究，146名无症状的有冠状动脉危险因素的成年人。至少有1个冠状动脉危险因素（bbb45岁）的参与者接受了计算机断层扫描（CT）检查，在1990-1992年期间进行筛查，在CT扫描后长达8.5年的时间里每年联系一次，并评估冠心病。该分析包括1312名具有CACS结果的参与者；排除了269名糖尿病患者和14名数据缺失或在行CACS前有冠状动脉事件的患者。主要观察指标：非致死性心肌梗死（MI）或chd死亡。结果在中位随访7年期间，84例患者发生心肌梗死或先天性心脏病死亡；70名患者死于各种原因。291名（28%）参与者的FRS超过20%，221名（21%）参与者的CACS超过300。与低于10%的FRS相比，高于20%的FRS预测心肌梗死或chd死亡的风险（风险比[HR]， 14.3； 95%可信区间[CI]； 2.0-104； P= 0.009）。与CACS为零相比，CACS大于300是可预测的(HR, 3.9; 95% CI, 2.1-7.3； P
Context Guidelines advise that all adults undergo coronary heart disease (CHD) risk assessment to guide preventive treatment intensity. Although the Framingham Risk Score (FRS) is often recommended for this, it has been suggested that risk assessment may be improved by additional tests such as coronary artery calcium scoring (CACS).Objectives To determine whether CACS assessment combined with FIRS in asymptomatic adults provides prognostic information superior to either method alone and whether the combined approach can more accurately guide primary preventive strategies in patients with CHID risk factors.Design, Setting, and Participants Prospective observational population-based study, of 146 asymptomatic adults with coronary risk factors. Participants with at least 1 coronary risk factor (>45 years) underwent computed tomography (CT) examination, were screened between 1990-1992, were contacted yearly for up to 8.5 years after CT scan, and were assessed for CHID. This analysis included 1312 participants with CACS results; excluded were 269 participants with diabetes and 14 participants with either missing data or had a coronary event before CACS was performed.Main Outcome Measure Nonfatal myocardial infarction (MI) or CHID death.Results During a median of 7.0 years of follow-up, 84 patients experienced MI or CHID death; 70 patients died of any cause. There were 291 (28%) participants with an FRS of more than 20% and 221 (21%) with a CACS of more than 300. Compared with an FRS of less than 10%, an FIRS of more than 20% predicted the risk of MI or CHID death (hazard ratio [HR], 14.3; 95% confidence interval [CI]; 2.0-104; P=.009). Compared with a CACS of zero, a CACS of more than 300 was predictive (HR, 3.9; 95% CI, 2.1-7.3; P