Coronary calcium does not accurately predict near-term future coronary events in high-risk adults
Coronary calcium does not accurately predict near-term future coronary events in high-risk adults
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DOI：
10.1161/01.cir.99.20.2633
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发表时间：
1999-05-25
期刊：
影响因子：
37.8
通讯作者：
Narahara, KA
中科院分区：
文献类型：
--
作者：
Detrano, RC;Wong, ND;Narahara, KA
背景-预测风险模型在预测具有多种危险因素的受试者的冠状动脉事件方面的成功有限。我们和其他人提出了一种使用放射学可检测到的冠状动脉钙的替代方法。我们评估并比较了这两种方法在有多个冠状动脉危险因素的无症状成人中确定冠状动脉事件风险的预测价值，此外，我们还评估了包括钙化评分和心脏危险因素数据的风险模型的预测价值。方法和结果：我们招募了1196名无症状高冠状动脉风险受试者，然后进行风险因素评估和心脏电子束CT(EBCT)扫描，并进行了41个月的随访，成功率为99%。我们应用Framingham模型和我们的数据衍生风险模型来确定冠状动脉事件发生3年的可能性。我们队列的平均年龄为66岁，平均3年弗雷明翰风险为3.3+/-3.6%。68%(818名受试者)有可检测到的冠状动脉钙化。冠状动脉死亡17例(1.4%)，非致死性心肌梗死29例(2.4%)。根据Framingham模型、我们的数据衍生风险模型计算的受试者操作特征(ROC)曲线面积和钙化评分分别为0.69+/-0.05、0.68+/-0.05和0.64+/-0.05(P=NS)，当将钙化评分作为变量纳入数据衍生模型时，ROC面积没有显著变化(0.68+/-0.05到0.71+/-0.04；结论：无论是风险因素评估还是EBCT钙化评分都不是高危无症状成人的准确事件预测指标，EBCT钙化评分不能为风险因素增加显著的增量信息，目前它在临床筛查中的应用尚不合理。
Background-Prognostic risk models have had limited success in predicting coronary events in subjects with multiple risk factors. We and others have proposed an alternative approach using radiographically detectable coronary calcium. We evaluated and compared the predictive value of these 2 approaches for determining coronary event risk in asymptomatic adults with multiple coronary risk factors, In addition, we assessed the predictive value of a risk model that included calcium score and cardiac risk-factor data.Methods and Results-We recruited 1196 asymptomatic high-coronary-risk subjects who then underwent risk-factor assessment and cardiac electron-beam CT (EBCT) scanning and were followed up for 41 months with a 99% success rate. We applied the Framingham model and our data-derived risk model to determine the 3-year likelihood of a coronary event. The mean age of our cohort was 66 years, and mean 3-year Framingham risk was 3.3+/-3.6%. Sixty-eight percent (818 subjects) had detectable coronary calcium. There were 17 coronary deaths (1.4%) and 29 nonfatal infarctions (2.4%). The receiver operating characteristic (ROC) curve areas calculated from the Framingham model, our data-derived risk model, and the calcium score were 0.69+/-0.05, 0.68+/-0.05, and 0.64+/-0.05, respectively (P=NS), When calcium score was included as a variable in the data-derived model, the ROC area did not change significantly (0.68+/-0.05 to 0.71+/-0.04; P=NS).Conclusions-Neither risk-factor assessment nor EBCT calcium is an accurate event predictor in high-risk asymptomatic adults, EBCT calcium score does not add significant incremental information to risk factors, and its use in clinical screening is not justified at this time.