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冠状动脉钙化积分在冠心病中的研究进展
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Abstract:
冠状动脉粥样硬化的临床表现是冠状动脉疾病(CAD)，其症状从因冠状动脉血流储备减少而引起的劳力性胸痛到因通常为非阻塞性斑块破裂而引起的冠状动脉血流突然减少而引起的急性冠状动脉综合征。CAD是全世界发病率和死亡率的主要原因。因此，识别CAD无症状高危人群是指导一级预防决策的关键。冠状动脉钙(CAC)是冠状动脉粥样硬化的标志。它可以通过心脏计算机断层扫描检测到，并通过Agatston方法进行量化。CAC检查是一种廉价、快速、低辐射剂量的检查，无需注射造影剂。它提供了其他传统心血管风险标志物和已建立的评分系统的预后信息，特别是对于低风险亚群体，如妇女和年轻人，并指示实施一级预防的适当时机，包括乙酰水杨酸和他汀类药物。在这篇综述中，我们讨论了CAC评估的方法，CAC评分为零的意义，其转化为CAC > 0及其对心血管风险的影响，他汀类药物和蛋白酶转化酶/可欣9型抑制剂对CAC进展的影响，CAC结果的解释，以及无症状和有症状患者的CAC预后价值。
The clinical manifestation of coronary artery atherosclerosis is coronary artery disease (CAD) with symptoms ranging from exertional chest pain due to reduction of coronary flow reserve to acute coronary syndrome due to rupture of usually a nonobstructive plaque with abrupt coronary blood flow reduction. CAD is the leading cause of morbidity and mortality worldwide. Therefore, identifying asymptomatic people at risk of CAD is pivotal to guide decision-making for primary prevention. Coronary artery calcium (CAC) is a hallmark of coronary artery atherosclerosis. It can be detected using cardiac computed tomography and quantified by the Agatston method. CAC examination is a cheap, fast and low radiation dose test, without injecting a contrast agent. It provides prognostic information over other traditional cardiovascular risk markers and established scoring systems, especially for low-risk subgroups such as women and younger adults, and indicates the appropriate moment to implement primary prevention, including acetylsalicylic acid and statins. In this review, we discuss the methods of CAC evaluation, the meaning of a zero CAC score (CACS), its conversion to CACS > 0 and the impact of this fact on cardiovascular risk, the effect of statins and proprotein convertase subtilisin kexin type 9 inhibitor on CAC progression, interpreta-tion of CACS results, and CACS prognostic value in both asymptomatic and symptomatic patients.
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