Coronary Artery Calcium Scoring Does Not Add Prognostic Value to Standard 64-Section CT Angiography Protocol in Low-Risk Patients Suspected of Having Coronary Artery Disease
Coronary Artery Calcium Scoring Does Not Add Prognostic Value to Standard 64-Section CT Angiography Protocol in Low-Risk Patients Suspected of Having Coronary Artery Disease
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DOI：
10.1148/radiol.10100886
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发表时间：
2011-04-01
期刊：
影响因子：
19.7
通讯作者：
Chang, Hyuk-Jae
中科院分区：
文献类型：
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作者：
Kwon, Sung Woo;Kim, Young Jin;Chang, Hyuk-Jae
目的：评估心脏计算机断层扫描（CT）预测疑似患有冠状动脉疾病（CAD）的低风险患者重大不良心脏事件（MACE）的预后结果，并探讨冠状动脉钙（CAC）评分和冠状动脉CT血管造影的不同预后价值。材料和方法：获得机构审查委员会的批准和知情同意。在4338例接受64层CT评估疑似CAD的患者中，使用标准扫描方案同时进行CAC评分和CT血管造影。获得了关于复合MACE的随访临床结局数据。开发了多变量考克斯比例风险模型来预测MACE。风险调整模型纳入传统的危险因素CAC评分和冠状动脉CT angiography.Results：在平均随访828天6380，有105个MACE，事件率为3%。冠状动脉CT血管造影显示的阻塞性CAD具有独立的预后价值，根据狭窄血管的数量而增加（P <0.001）。在受试者工作特征曲线（ROC）分析中，冠状动脉CT血管造影术优于CAC评分，其ROC曲线下面积（AUC）显著更大。（0.892 vs 0.810，P < .001），而CAC评分对冠状动脉CT血管造影的增加没有显著的增量价值（AUC = 0.892，单独冠状动脉CT血管造影vs 0.902加上CAC评分，P = 0.198）。结论：在怀疑患有CAD的低风险患者中，冠状动脉CT血管造影在预测MACE方面优于CAC评分。此外，目前的标准多切片CT方案（冠状动脉CT血管造影结合CAC评分）与单独的冠状动脉CT血管造影相比没有增加的预后价值。因此，在确定预后方面，CAC评分可能不再需要纳入该人群的心脏CT方案中。(C)RSNA，2011年
Purpose: To evaluate the prognostic outcome of cardiac computed tomography (CT) for prediction of major adverse cardiac events (MACEs) in low-risk patients suspected of having coronary artery disease (CAD) and to explore the differential prognostic values of coronary artery calcium (CAC) scoring and coronary CT angiography.Materials and Methods: Institutional review committee approval and informed consent were obtained. In 4338 patients who underwent 64-section CT for evaluation of suspected CAD, both CAC scoring and CT angiography were concurrently performed by using standard scanning protocols. Follow-up clinical outcome data regarding composite MACEs were procured. Multivariable Cox proportional hazards models were developed to predict MACEs. Risk-adjusted models incorporated traditional risk factors for CAC scoring and coronary CT angiography.Results: During the mean follow-up of 828 days 6 380, there were 105 MACEs, for an event rate of 3%. The presence of obstructive CAD at coronary CT angiography had independent prognostic value, which escalated according to the number of stenosed vessels (P < .001). In the receiver operating characteristic curve (ROC) analysis, the superiority of coronary CT angiography to CAC scoring was demonstrated by a significantly greater area under the ROC curve (AUC) (0.892 vs 0.810, P < .001), whereas no signifi cant incremental value for the addition of CAC scoring to coronary CT angiography was established (AUC = 0.892 for coronary CT angiography alone vs 0.902 with addition of CAC scoring, P = .198).Conclusion: Coronary CT angiography is better than CAC scoring in predicting MACEs in low-risk patients suspected of having CAD. Furthermore, the current standard multisection CT protocol (coronary CT angiography combined with CAC scoring) has no incremental prognostic value compared with coronary CT angiography alone. Therefore, in terms of determining prognosis, CAC scoring may no longer need to be incorporated in the cardiac CT protocol in this population. (C) RSNA, 2011