Long-term prognosis associated with coronary calcification - Observations from a registry of 25,253 patients
Long-term prognosis associated with coronary calcification - Observations from a registry of 25,253 patients
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DOI：
10.1016/j.jacc.2006.10.079
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发表时间：
2007-05-08
影响因子：
24
通讯作者：
Berman, Daniel S.
中科院分区：
文献类型：
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作者：
Budoff, Matthew J.;Shaw, Leslee J.;Berman, Daniel S.
本研究的目的是建立风险调整多变量模型，包括无症状患者的危险因素和冠状动脉钙（CAC）评分，用于预测全因死亡率。几项规模较小的研究证实了CAC检测对心血管风险评估的有效性。规模更大、随访时间更长的研究将支持CAC检测将改善初级预防工作的结果、成本效益和安全性的假设。我们采用了一项观察性结果研究，纳入了25253名连续无症状患者，由其主治医生推荐进行CAC扫描以评估心血管风险。建立了多变量Cox比例风险模型来预测全因死亡率。风险调整模型纳入了冠心病的传统危险因素和CAC评分。0分、1分至10分、11分至100分、101分至400分、401分至1000分、bb0 1000分的CAC评分频率分别为44%、14%、20%、13%、6%、4%。在平均6.8 - 3年的随访期间，死亡率为2%（510例死亡）。在控制年龄、性别、种族和心脏危险因素的多变量模型中，CAC是死亡率的独立预测因子（模型卡方= 2017,p < 0.0001）。在传统危险因素中加入CAC显著提高了一致性指数（危险因素0.61比CAC评分0.81,p < 0.0001）。与0分相比，CAC的风险调整后的相对风险比分别为2.2倍、4.5倍、6.4倍、9.2倍、10.4倍和12.5倍，分别为11至100分、101至299分、300至399分、400至699分、700至999分和bbb1000分（p < 0.0001）。CAC评分为0的患者10年生存率（包括年龄在内的危险因素调整后）为99.4%，评分为1000分的患者10年生存率为87.8% （p < 0.0001）。这一系列大型观测数据表明，除了传统的危险因素外，CAC在预测全因死亡率方面提供了独立的增量信息。[J]中华医学会心脏科杂志2007；49::60-70](C) 2007。
The purpose of this study was to develop risk-adjusted multivariable models that include risk factors and coronary artery calcium (CAC) scores measured with electron-beam tomography in asymptomatic patients for the prediction of all-cause mortality. Several smaller studies have documented the efficacy of CAC testing for assessment of cardiovascular risk. Larger studies with longer follow-up will lend strength to the hypothesis that CAC testing will improve outcomes, cost-effectiveness, and safety of primary prevention efforts. We used an observational outcome study of a cohort of 25,253 consecutive, asymptomatic individuals referred by their primary physician for CAC scanning to assess cardiovascular risk. Multivariable Cox proportional hazards models were developed to predict all-cause mortality. Risk-adjusted models incorporated traditional risk factors for coronary disease and CAC scores. The frequency of CAC scores was 44%, 14%, 20%, 13%, 6%, and 4% for scores of 0, 1 to 10, 11 to 100, 101 to 400, 401 to 1,000, and > 1,000, respectively. During a mean follow-up of 6.8 - 3 years, the death rate was 2% (510 deaths). The CAC was an independent predictor of mortality in a multivariable model controlling for age, gender, ethnicity, and cardiac risk factors (model chi-square = 2,017, p < 0.0001). The addition of CAC to traditional risk factors increased the concordance index significantly (0.61 for risk factors vs. 0.81 for the CAC score, p < 0.0001). Risk-adjusted relative risk ratios for CAC were 2.2-, 4.5-, 6.4-, 9.2-, 10.4-, and 12.5-fold for scores of 11 to 100, 101 to 299, 300 to 399, 400 to 699, 700 to 999, and > 1,000, respectively (p < 0.0001), when compared with a score of 0. Ten-year survival (after adjustment for risk factors, including age) was 99.4% for a CAC score of 0 and worsened to 87.8% for a score of > 1,000 (p < 0.0001). This large observational data series shows that CAC provides independent incremental information in addition to traditional risk factors in the prediction of all-cause mortality. (J Am Coll Cardiol 2007;49::1860-70) (C) 2007 by the American College of Cardiology Foundation.