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首页> 外文期刊>Journal of the American College of Cardiology >Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease.
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Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease.

机译：根据国际多中心CONFIRM（临床结果的冠状CT血管造影评估：国际多中心注册）对23,854名无已知冠状动脉疾病的患者进行的基于冠状动脉计算机断层扫描血管造影结果的年龄和性别相关的全因死亡率风险差异。

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OBJECTIVES: We examined mortality in relation to coronary artery disease (CAD) as assessed by >/=64-detector row coronary computed tomography angiography (CCTA). BACKGROUND: Although CCTA has demonstrated high diagnostic performance for detection and exclusion of obstructive CAD, the prognostic findings of CAD by CCTA have not, to date, been examined for age- and sex-specific outcomes. METHODS: We evaluated a consecutive cohort of 24,775 patients undergoing >/=64-detector row CCTA between 2005 and 2009 without known CAD who met inclusion criteria. In these patients, CAD by CCTA was defined as none (0% stenosis), mild (1% to 49% stenosis), moderate (50% to 69% stenosis), or severe (>/=70% stenosis). CAD severity was judged on a per-patient, per-vessel, and per-segment basis. Time to mortality was estimated using multivariable Cox proportional hazards models. RESULTS: At a 2.3 +/- 1.1-year follow-up, 404 deaths had occurred. In risk-adjusted analysis, both per-patient obstructive (hazard ratio [HR]: 2.60; 95% confidence interval [CI]: 1.94 to 3.49; p < 0.0001) and nonobstructive (HR: 1.60; 95% CI: 1.18 to 2.16; p = 0.002) CAD conferred increased risk of mortality compared with patients without evident CAD. Incident mortality was associated with a dose-response relationship to the number of coronary vessels exhibiting obstructive CAD, with increasing risk observed for nonobstructive (HR: 1.62; 95% CI: 1.20 to 2.19; p = 0.002), obstructive 1-vessel (HR: 2.00; 95% CI: 1.43 to 2.82; p < 0.0001), 2-vessel (HR: 2.92; 95% CI: 2.00 to 4.25; p < 0.0001), or 3-vessel or left main (HR: 3.70; 95% CI: 2.58 to 5.29; p < 0.0001) CAD. Importantly, the absence of CAD by CCTA was associated with a low rate of incident death (annualized death rate: 0.28%). When stratified by age <65 years versus >/=65 years, younger patients experienced higher hazards for death for 2-vessel (HR: 4.00; 95% CI: 2.16 to 7.40; p < 0.0001 vs. HR: 2.46; 95% CI: 1.51 to 4.02; p = 0.0003) and 3-vessel (HR: 6.19; 95% CI: 3.43 to 11.2; p < 0.0001 vs. HR: 3.10; 95% CI: 1.95 to 4.92; p < 0.0001) CAD. The relative hazard for 3-vessel CAD (HR: 4.21; 95% CI: 2.47 to 7.18; p < 0.0001 vs. HR: 3.27; 95% CI: 1.96 to 5.45; p < 0.0001) was higher for women as compared with men. CONCLUSIONS: Among individuals without known CAD, nonobstructive and obstructive CAD by CCTA are associated with higher rates of mortality, with risk profiles differing for age and sex. Importantly, absence of CAD is associated with a very favorable prognosis.
机译：目的：我们检查了与冠状动脉疾病（CAD）相关的死亡率，该死亡率通过> / = 64探测器行冠状动脉计算机断层扫描血管造影（CCTA）进行评估。背景：尽管CCTA已显示出对阻塞性CAD的检测和排除的高诊断性能，但迄今为止，尚未通过CCTA进行针对年龄和性别的特定结局的CAD预后研究。方法：我们评估了2005年至2009年间连续行24,775例行≥64排CCTA的患者，他们均不符合纳入标准的已知CAD。在这些患者中，CCTA将CAD定义为无（0％狭窄），轻度（1％至49％狭窄），中度（50％至69％狭窄）或严重（> / = 70％狭窄）。根据每个患者，每个血管和每个细分来判断CAD严重程度。使用多变量Cox比例风险模型估算死亡率。结果：在2.3 +/- 1.1年的随访中，发生了404例死亡。在风险调整后的分析中，每位患者的阻塞性（危险比[HR]：2.60; 95％置信区间[CI]：1.94至3.49; p <0.0001）和非阻塞性（HR：1.60; 95％CI：1.18至2.16） ; p = 0.002）与没有明显CAD的患者相比，CAD可以增加死亡风险。事故死亡率与显示阻塞性冠状动脉的冠状动脉血管数目的剂量-反应关系有关，观察到非阻塞性（HR：1.62; 95％CI：1.20至2.19; p = 0.002），阻塞性1血管（HR ：2.00; 95％CI：1.43至2.82; p <0.0001），2血管（HR：2.92; 95％CI：2.00至4.25; p <0.0001），或3血管或左主干（HR：3.70; 95 ％CI：2.58至5.29; p ＜0.0001）CAD。重要的是，CCTA缺乏CAD与事件死亡率低相关（年死亡率：0.28％）。当按年龄<65岁和> / = 65岁进行分层时，年轻患者的两支血管死亡风险更高（HR：4.00; 95％CI：2.16至7.40; P <0.0001 vs. HR：2.46; 95％CI ：1.51至4.02; p ＝ 0.0003）和3血管（HR：6.19; 95％CI：3.43至11.2; p ＜0.0001，相对于HR：3.10; 95％CI：1.95至4.92; p ＜0.0001）CAD。与男性相比，女性三血管CAD的相对危险性（HR：4.21; 95％CI：2.47至7.18; p <0.0001 vs.HR：3.27; 95％CI：1.96至5.45; p <0.0001）与男性相比更高。结论：在没有已知CAD的个体中，CCTA进行的非阻塞性和阻塞性CAD与较高的死亡率相关，且年龄和性别的风险特征不同。重要的是，不存在CAD与非常有利的预后相关。

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