Improving the CAC Score by Addition of Regional Measures of Calcium Distribution: Multi-Ethnic Study of Atherosclerosis.
Improving the CAC Score by Addition of Regional Measures of Calcium Distribution: Multi-Ethnic Study of Atherosclerosis.
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DOI：
10.1016/j.jcmg.2016.03.001
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发表时间：
2016-12
期刊：
影响因子：
--
通讯作者：
Nasir K
中科院分区：
文献类型：
--
作者：
Blaha MJ;Budoff MJ;Tota-Maharaj R;Dardari ZA;Wong ND;Kronmal RA;Eng J;Post WS;Blumenthal RS;Nasir K
我们研究了钙化斑块分布的简单测量是否可以提高传统的Agatston冠状动脉钙化（CAC）评分预测心血管事件的能力。Agatston CAC评分不包括可检测钙化斑块的位置和分布模式的信息。我们研究了来自多种族动脉粥样硬化研究（梅萨）的3，262名（50%）基线CAC >0的个体。多血管CAC定义为CAC的冠状动脉血管数量（评分为1 - 4，包括左主干）。“扩散指数”计算为1 -（最受影响血管的CAC/总CAC），并用于将参与者分组为集中和扩散CAC模式。对冠心病（CHD）和心血管疾病（CVD）事件进行多变量考克斯比例风险回归、曲线下面积（AUC）和净重新分类改善（NRI）分析，以评估区域CAC分布的测量是否增加了传统的Agatston CAC评分。人群的平均年龄为66 ± 10岁，其中42%为女性。中位随访时间为10.0（9.5 - 10.7）年，随访期间发生368例CHD和493例CVD事件。CAC评分组与CAC血管数之间存在显著的异质性（p<0.01）。在生存分析（4支血管与1支血管CAC的HR为1.9-3.5）、AUC分析（C统计学改善0.01-0.033）和NRI分析（无类别NRI 0.10-0.45）中，增加CAC血管数量显著提高了预测CHD和CVD事件的能力。虽然弥漫性CAC模式与≥2支CAC血管的受试者结局较差相关（HR 1.33-1.41，p<0.05），但将此变量添加到Agatston CAC评分和CAC血管数量中并不能进一步改善总体风险预测。钙化斑块的冠状动脉数量，表明越来越多的“弥漫性”多血管亚临床动脉粥样硬化，显着增加了传统的Agatston CAC评分预测CHD和CVD事件。
We investigated whether inclusion of simple measures of calcified plaque distribution might improve the ability of the traditional Agatston coronary artery calcium (CAC) score to predict cardiovascular events. Agatston CAC scoring does not include information on the location and distributional pattern of detectable calcified plaque. We studied 3,262 (50%) individuals with baseline CAC >0 from the Multi-Ethnic Study of Atherosclerosis (MESA). Multi-vessel CAC was defined by the number of coronary vessels with CAC (scored 1 to 4, including the left main). The “diffusivity index” was calculated as 1 – (CAC in most affected vessel/total CAC), and was used to group participants into concentrated and diffuse CAC patterns. Multivariable Cox proportional hazards regression, area under the curve (AUC), and net reclassification improvement (NRI) analyses were performed for both coronary heart disease (CHD) and cardiovascular disease (CVD) events to assess whether measures of regional CAC distribution add to the traditional Agatston CAC score. Mean age of the population was 66 ± 10 years, with 42% women. Median follow-up was 10.0 (9.5 – 10.7) years and there were 368 CHD and 493 CVD events during follow-up. Considerable heterogeneity existed between CAC score group and number of vessels with CAC (p<0.01). Addition of number of vessels with CAC significantly improved capacity to predict CHD and CVD events in survival analysis (HR 1.9-3.5 for 4-vessel vs. 1-vessel CAC), AUC analysis (C-statistic improvement of 0.01-0.033), and NRI analysis (category-less NRI 0.10-0.45) analyses. While a diffuse CAC pattern was associated with worse outcomes in participants with ≥2 vessels with CAC (HR 1.33-1.41, p<0.05), adding this variable to the Agatston CAC score and number of vessels with CAC did not further improve global risk prediction. The number of coronary arteries with calcified plaque, indicating increasingly “diffuse” multi-vessel subclinical atherosclerosis, adds significantly to the traditional Agatston CAC score for the prediction of CHD and CVD events.
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影响因子：
2
作者：
Pencina, Michael J.;D'Agostino, Ralph B., Sr.;Steyerberg, Ewout W.
通讯作者：
Steyerberg, Ewout W.
影响因子：
158.5
作者：
Detrano, Robert;Guerci, Alan D.;Kronmal, Richard A.
通讯作者：
Kronmal, Richard A.
DOI：
10.1016/0735-1097(90)90282-t
发表时间：
1990-03-15
影响因子：
24
作者：
AGATSTON, AS;JANOWITZ, WR;DETRANO, R
通讯作者：
DETRANO, R
影响因子：
24
作者：
Motoyama, Sadako;Sarai, Masayoshi;Narula, Jagat
通讯作者：
Narula, Jagat
影响因子：
24
作者：
Budoff, Matthew J.;Shaw, Leslee J.;Berman, Daniel S.
通讯作者：
Berman, Daniel S.