The Absence of Coronary Calcification Does Not Exclude Obstructive Coronary Artery Disease or the Need for Revascularization in Patients Referred for Conventional Coronary Angiography
The Absence of Coronary Calcification Does Not Exclude Obstructive Coronary Artery Disease or the Need for Revascularization in Patients Referred for Conventional Coronary Angiography
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DOI：
10.1016/j.jacc.2009.07.072
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发表时间：
2010-02-16
影响因子：
24
通讯作者：
Rochitte, Carlos E.
中科院分区：
文献类型：
--
作者：
Gottlieb, Ilan;Miller, Julie M.;Rochitte, Carlos E.
目的本研究旨在评价冠状动脉钙缺乏是否可以排除>= 50%的冠状动脉狭窄或需要进行血管重建。背景最新的美国心脏协会指南建议，钙评分（CS）为零可能排除有症状患者需要进行冠状动脉造影。方法对CORE 64进行亚组研究，（使用64探测器的多探测器螺旋计算机断层扫描血管造影进行冠状动脉评价）比较64探测器计算机断层扫描与传统血管造影诊断性能的多中心试验。临床上提到的常规血管造影患者被要求进行CS扫描到30 daybefore.Results，在所有，291例患者，其中214（73%）是男性，平均年龄为59.3 +/- 10.0岁。共有14例（5%）患者的阻塞性冠状动脉疾病的检测前概率较低，218例（75%）患者的阻塞性冠状动脉疾病的检测前概率中等，59例（20%）患者的阻塞性冠状动脉疾病的检测前概率较高。狭窄>= 50%的总体患病率为56%。共有72例患者CS = 0，其中14例（19%）至少有1 >= 50%狭窄。CS = 0预测不存在≥ 50%狭窄的总体敏感性为45%，特异性为91%，阴性预测值为68%，阳性预测值为81%。此外，9例（12.5%）CS = 0患者在CS后30天内进行了血运重建。在383支无冠状动脉钙化的血管中，47支（12%）狭窄≥ 50%;从总共64个完全闭塞的血管中，13名（20%）结论：在高度怀疑有冠状动脉疾病的患者中，没有冠状动脉钙化并不能排除阻塞性狭窄或需要进行血运重建以进行冠状动脉造影。血管造影，与已发表的建议相反。完全冠状动脉闭塞经常发生在没有任何可检测到的钙化。（使用64个探测器的多探测器螺旋计算机断层扫描血管造影术进行冠状动脉评价[CORE-64]; NCT 00738218）（J Am科尔心脏病学杂志2010;55：627-34）（C）美国心脏病学会基金会2010年
Objectives This study was designed to evaluate whether the absence of coronary calcium could rule out >= 50% coronary stenosis or the need for revascularization.Background The latest American Heart Association guidelines suggest that a calcium score (CS) of zero might exclude the need for coronary angiography among symptomatic patients.Methods A substudy was made of the CORE64 (Coronary Evaluation Using Multi-Detector Spiral Computed Tomography Angiography Using 64 Detectors) multicenter trial comparing the diagnostic performance of 64-detector computed tomography to conventional angiography. Patients clinically referred for conventional angiography were asked to undergo a CS scan up to 30 days before.Results In all, 291 patients were included, of whom 214 (73%) were male, and the mean age was 59.3 +/- 10.0 years. A total of 14 (5%) patients had low, 218 (75%) had intermediate, and 59 (20%) had high pre-test probability of obstructive coronary artery disease. The overall prevalence of >= 50% stenosis was 56%. A total of 72 patients had CS = 0, among whom 14 (19%) had at least 1 >= 50% stenosis. The overall sensitivity for CS = 0 to predict the absence of >= 50% stenosis was 45%, specificity was 91%, negative predictive value was 68%, and positive predictive value was 81%. Additionally, revascularization was performed in 9 (12.5%) CS = 0 patients within 30 days of the CS. From a total of 383 vessels without any coronary calcification, 47 (12%) presented with >= 50% stenosis; and from a total of 64 totally occluded vessels, 13 (20%) had no calcium.Conclusions The absence of coronary calcification does not exclude obstructive stenosis or the need for revascularization among patients with high enough suspicion of coronary artery disease to be referred for coronary angiography, in contrast with the published recommendations. Total coronary occlusion frequently occurs in the absence of any detectable calcification. (Coronary Evaluation Using Multi-Detector Spiral Computed Tomography Angiography Using 64 Detectors [CORE-64]; NCT00738218) (J Am Coll Cardiol 2010;55:627-34) (C) 2010 by the American College of Cardiology Foundation