Quantification of coronary artery calcium in nongated CT to predict cardiovascular events in male lung cancer screening participants: Results of the NELSON study

被引:57
作者
Takx, Richard A. P. [1 ]
Isgum, Ivana [2 ]
Willemink, Martin J. [1 ]
van der Graaf, Yolanda [3 ]
de Koning, Harry J. [4 ]
Vliegenthart, Rozemarijn [5 ,6 ]
Oudkerk, Matthijs [5 ]
Leiner, Tim [1 ]
de Jong, Pim A. [1 ]
机构
[1] Univ Med Ctr Utrecht, Dept Radiol, NL-3508 GA Utrecht, Netherlands
[2] Univ Med Ctr Utrecht, Image Sci Inst, NL-3508 GA Utrecht, Netherlands
[3] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, NL-3508 GA Utrecht, Netherlands
[4] Erasmus MC, Dept Publ Hlth, Rotterdam, Netherlands
[5] Univ Groningen, Univ Med Ctr Groningen, Ctr Med Imaging North East Netherlands, Groningen, Netherlands
[6] Univ Groningen, Univ Med Ctr Groningen, Dept Radiol, Groningen, Netherlands
关键词
Lung cancer screening; Computed tomography; Cardiovascular event; PROGNOSTIC VALUE; HEART-DISEASE; RISK; CALCIFICATION; SCORE; ATHEROSCLEROSIS; EPIDEMIOLOGY; IMPROVEMENT; POPULATION; MDCT;
D O I
10.1016/j.jcct.2014.11.006
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To evaluate the incremental prognostic value of the number and maximum volume of coronary artery calcifications over modified Agatston score strata, age, pack-years, and smoking status for predicting cardiovascular events. Methods: A total of 3559 male current and former smokers received a CT examination for lung cancer screening. Smoking characteristics, patient demographics, and physician-diagnosed cardiovascular events were collected. Images were acquired without electro-cardiography gating on 16-slice CT scanners. The association between the presence of both fatal and nonfatal cardiovascular events and the predictors was quantified using Cox proportional hazard analysis. Results: Median follow-up period was 2.9 years. Incident cardiovascular events occurred in 186 participants. Adjusted hazard ratios for modified Agatston score strata of 1 to 10, 11 to 100, 101 to 400, and >400 were 3.39 (95% confidence interval [CI], 1.20-9.59), 6.52 (95% CI, 2.73-15.60), 6.58 (95% CI, 2.75-15.78), and 12.58, (95% CI, 5.42-29.16), respectively. Moreover, comparing the models with and without Modified Agatston score strata to the model with age, pack-years, and smoking status yielded a significantly better net reclassification improvement (NRI; 27.3%; P < .0001). Adding the number of calcifications to the model with age, pack-years, smoking status, and modified Agatston score strata resulted in a slightly better NRI (1.68%; P = .0490) with a hazard ratio of 1.13 (95% CI, 1.05-1.21) per 10 calcificatiOns. The incremental prognostic information contained in the volume of the largest calcification was not statistically significant (NRI, 0.14%; P = .3458). Conclusion: Cardiovascular event rate increased with higher numbers of calcified lesions. The number but not maximum volume of calcifications has independent, although minimal, prognostic value over age, pack-years, smoking status, and modified Agatston score strata in our population. (C) 2015 Society of Cardiovascular Computed Tomography. All rights reserved.
引用
收藏
页码:50 / 57
页数:8
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