Prognostic significance of coronary artery calcium in asymptomatic subjects with usual cardiovascular risk
Prognostic significance of coronary artery calcium in asymptomatic subjects with usual cardiovascular risk
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DOI：
10.1067/mhj.2003.169
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发表时间：
2003-03-01
影响因子：
4.8
通讯作者：
Vagenakis, AG
中科院分区：
文献类型：
--
作者：
Alexopoulos, D;Toulgaridis, T;Vagenakis, AG
背景：无创检测冠状动脉钙是一种在症状出现前诊断动脉粥样硬化的有吸引力的方法。本研究探讨冠状动脉钙化对无症状且有心血管危险患者的预后价值。方法和结果在425名无症状患者中，229名男性（年龄45.1 +/- 14岁）和196名女性（年龄42.7 +/- 13岁），通过数字电影透视检查冠状动脉钙的存在。大多数（76%）没有或最多有一个危险因素。随访时间为58.4±12.7个月。425名受试者中有76名（17.9%）出现冠状动脉钙化。在21例受试者中观察到心脏事件：2例心源性死亡，7例急性心肌梗死，3例冠状动脉搭桥术，3例冠状动脉成形术，3例不稳定型心绞痛，10例稳定型心绞痛。生存曲线分析显示，补钙组和不补钙组的所有研究终点均有显著差异。冠状动脉钙化是所有事件的独立预测因子（3.6倍增加，P < 0.008）、心源性死亡/心肌梗死/血运重建术（13.9倍增加，P < 0.02）和稳定型心绞痛（7.4倍增加，P < 0.007）。然而，钙不能独立预测心源性死亡/心肌梗死或急性冠状动脉综合征。结论无症状且有心血管危险的受试者冠状动脉钙化水平为有症状的冠状动脉疾病的发生提供了重要的危险因素信息。
Background Coronary calcium detected noninvasively is an attractive way to diagnose atherosclerosis before the development of symptoms. This study examines the prognostic value of coronary calcium in asymptomatic subjects with usual cardiovascular risk.Methods and Results In 425 asymptomatic subjects, 229 men,(aged 45.1 +/- 14 years) and 196 women (aged 42.7 +/- 13 years), coronary calcium presence was studied by digital cinefluoroscopy. The majority (76 %) had no or at most one risk factor. Subjects were followed up for 58.4 +/- 12.7 months for cardiac events. Coronary calcium was present in 76 of 425 (17.9%) subjects. Cardiac events were observed in 21 subjects: 2 cardiac deaths, 7 acute (myocardial infarctions, 3 coronary artery bypass grafts, 3 coronary angioplasty procedures, 3, events of unstable angina, and 10 events of stable angina pectoris. Survival curve analysis showed significant differences in all the studied end points between subjects with and those without calcium. Coronary calcium was an independent predictor of all events (3.6-fold increase, P < .008), cardiac death/myocardial infarction/revascularization (13.9-fold increase, P < .02), and stable angina (7.4-fold increase, P < .007). However, calcium did not independently predict cardiac death/myocardial infarction or acute coronary syndromes.Conclusions Coronary calcium in asymptomatic subjects with usual cardiovascular risk adds significant incremental information to risk factors information for the development of symptomatic coronary artery disease.