Measurement of coronary calcium scores by electron beam computed tomography or exercise testing as initial diagnostic tool in low-risk patients with suspected coronary artery disease
Measurement of coronary calcium scores by electron beam computed tomography or exercise testing as initial diagnostic tool in low-risk patients with suspected coronary artery disease
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DOI：
10.1007/s00330-007-0755-2
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发表时间：
2008-02-01
影响因子：
5.9
通讯作者：
Zijlstra, Felix
中科院分区：
文献类型：
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作者：
Geluk, Christiane A.;Dikkers, Riksta;Zijlstra, Felix
我们确定了基于冠状动脉钙化评分（CCS）的筛查方案的有效性，并与疑似冠心病（CAD）、ECG和肌钙蛋白水平正常的患者进行运动试验进行了比较。304例患者参加了包括CCS电子束计算机断层扫描（Agatston评分）和运动试验的筛选方案。决策是基于CCS。当CCS >= 400时，建议进行冠状动脉造影（CAG）。当CCS < 10时，患者出院。运动试验分为阳性、阴性或非诊断性。联合终点定义为CAG时的冠状动脉事件或阻塞性CAD。在12 +/- 4个月期间，CCS < 400、10-399和< 10分别见于42、103和159例患者，联合终点分别见于24例（57%）、14例（14%）和0例（0%）患者。在22例患者（7%）中，由于无法进行运动试验，因此进行了心肌灌注造影术而不是运动试验。在37、76和191例患者中发现了阳性、非诊断性和阴性运动试验结果，分别在11例（30%）、15例（20%）和12例（6%）患者中出现了联合终点。受试者-操作者特征分析显示，CCS的曲线下面积为0.89（95% CI：0.85-0.93），优于运动试验的曲线下面积0.69（95% CI：0.61-0.78）（P < 0.0001）。总之，测量CCS是一个适当的初步筛选测试，在一个明确的低风险人群怀疑CAD。
We determined the efficiency of a screening protocol based on coronary calcium scores (CCS) compared with exercise testing in patients with suspected coronary artery disease (CAD), a normal ECG and troponin levels. Three-hundred-and-four patients were enrolled in a screening protocol including CCS by electron beam computed tomography (Agatston score), and exercise testing. Decision-making was based on CCS. When CCS >= 400, coronary angiography (CAG) was recommended. When CCS < 10, patients were discharged. Exercise tests were graded as positive, negative or nondiagnostic. The combined endpoint was defined as coronary event or obstructive CAD at CAG. During 12 +/- 4 months, CCS < 400, 10-399 and < 10 were found in 42, 103 and 159 patients and the combined endpoint occurred in 24 (57%), 14 (14%) and 0 patients (0%), respectively. In 22 patients (7%), myocardial perfusion scintigraphy was performed instead of exercise testing due to the inability to perform an exercise test. A positive, nondiagnostic and negative exercise test result was found in 37, 76 and 191 patients, and the combined endpoint occurred in 11 (30%), 15 (20%) and 12 patients (6%), respectively. Receiver-operator characteristics analysis showed that the area under the curve of 0.89 (95% CI: 0.85-0.93) for CCS was superior to 0.69 (95% CI: 0.61-0.78) for exercise testing (P < 0.0001). In conclusion, measurement of CCS is an appropriate initial screening test in a well-defined low-risk population with suspected CAD.