Coronary Risk Stratification, Discrimination, and Reclassification Improvement Based on Quantification of Subclinical Coronary Atherosclerosis The Heinz Nixdorf Recall Study
Coronary Risk Stratification, Discrimination, and Reclassification Improvement Based on Quantification of Subclinical Coronary Atherosclerosis The Heinz Nixdorf Recall Study
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DOI：
10.1016/j.jacc.2010.06.030
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发表时间：
2010-10-19
影响因子：
24
通讯作者：
Joeckel, Karl-Heinz
中科院分区：
文献类型：
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作者：
Erbel, Raimund;Moehlenkamp, Stefan;Joeckel, Karl-Heinz
目的 本研究的目的是确定与传统危险因素相比，基于冠状动脉钙化 (CAC) 评分的净重分类改善 (NRI) 和改进的风险预测。背景 CAC 作为亚临床冠状动脉粥样硬化的标志，可以通过 CT 无创检测到，并建议预测冠状动脉事件。方法 在 HNR (Heinz Nixdorf Recall) 研究的 4,129 名受试者中（年龄 45 至 75 岁， 53% 女性）在基线时没有明显的冠状动脉疾病，测量了传统危险因素和 CAC 评分。根据弗雷明汉风险评分（FRS）和国家胆固醇教育专家组成人治疗专家组（ATP）III指南将其风险分为低、中、高，并根据CAC结果计算重新分类率。结果经过5年的随访，发生93例冠心病死亡和非致命性心肌梗死（累积风险2.3%；95%置信区间：1.8%至2.8%）。将 CAC = 400 的中度（定义为 10% 至 20% 和 6% 至 20%）风险受试者重新分类为高风险类别，FRS 的 NRI 分别为 21.7% (p = 0.0002) 和 30.6% (p < 0.0001)。使用 FRS 变量和 CAC 的综合辨别率改善为 1.52% (p < 0.0001)。将 CAC 评分添加到 FRS 和国家胆固醇教育面板 ATP III 类别中，曲线下面积分别从 0.681 提高到 0.749 (p < 0.003) 和从 0.653 提高到 0.755 (p = 0.0001)。 结论 CAC 评分导致中等风险队列的重新分类率较高，证明了亚临床冠状动脉成像的益处动脉粥样硬化。我们的研究支持其应用，特别是在精心挑选的具有中等风险的个体中。 (J Am Coll Cardiol 2010;56:1397-406) (C) 2010 年，美国心脏病学会基金会
Objectives The purpose of this study was to determine net reclassification improvement (NRI) and improved risk prediction based on coronary artery calcification (CAC) scoring in comparison with traditional risk factors.Background CAC as a sign of subclinical coronary atherosclerosis can noninvasively be detected by CT and has been suggested to predict coronary events.Methods In 4,129 subjects from the HNR (Heinz Nixdorf Recall) study (age 45 to 75 years, 53% female) without overt coronary artery disease at baseline, traditional risk factors and CAC scores were measured. Their risk was categorized into low, intermediate, and high according to the Framingham Risk Score (FRS) and National Cholesterol Education Panel Adult Treatment Panel (ATP) III guidelines, and the reclassification rate based on CAC results was calculated.Results After 5 years of follow-up, 93 coronary deaths and nonfatal myocardial infarctions occurred (cumulative risk 2.3%; 95% confidence interval: 1.8% to 2.8%). Reclassifying intermediate (defined as 10% to 20% and 6% to 20%) risk subjects with CAC = 400 to the high-risk category yielded an NRI of 21.7% (p = 0.0002) and 30.6% (p < 0.0001) for the FRS, respectively. Integrated discrimination improvement using FRS variables and CAC was 1.52% (p < 0.0001). Adding CAC scores to the FRS and National Cholesterol Education Panel ATP III categories improved the area under the curve from 0.681 to 0.749 (p < 0.003) and from 0.653 to 0.755 (p = 0.0001), respectively.Conclusions CAC scoring results in a high reclassification rate in the intermediate-risk cohort, demonstrating the benefit of imaging of subclinical coronary atherosclerosis. Our study supports its application, especially in carefully selected individuals with intermediate risk. (J Am Coll Cardiol 2010;56:1397-406) (C) 2010 by the American College of Cardiology Foundation