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The Korean Journal of Medicine 2010;78(4): 466-476.
선별검사 목적으로 시행된 관상동맥 CT의 석회수치에 따른 임상경과 관찰
정인현, 김정순, 남효정, 김희성, 김홍규, 박덕우, 이승환, 김영학, 이철환, 김재중, 박성욱, 박승정, 강준원, Jun-Won Kang
Clinical outcomes according to coronary calcium scores in asymptomatic individuals undergoing coronary CT angiography
In Hyun Jung, Jeong Soon Kim, Hyo-Jung Nam, Hee Sung Kim, R.N., Hong Kyu Kim, Duk-Woo Park, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee, Jae-Joong Kim, Seong-Wook Park, Seung-Jung Park, Jun-Won Kang
In general, multidetector computed tomography (MDCT) is not recommended as a screening tool for asymptomatic individuals. However, the programs for general health evaluation at several hospitals in Korea include MDCT to detect cardiac disease. The objectives of this study were to evaluate the clinical outcomes of asymptomatic individuals according to the coronary artery calcium score (CACS) obtained from screening MDCT and to assess the eligibility of risk stratification in the NCEP-ATP III guidelines for predicting a significant stenosis on MDCT.
We reviewed the medical records of 845 asymptomatic subjects (age 53±9 years, 67% men) who underwent MDCT as part of a general health evaluation at Asan Medical Center, Seoul, Korea, from January to December 2008.
Atherosclerotic plaques were identified in 332 (39.3%) subjects. Sixty (7.1%) individuals had significant stenosis (≥ 50% diameter stenosis). The prevalence of significant stenosis was higher in the group that had more than a 10% risk of coronary heart disease (CHD) at 10 years (p<0.05). Among the patients with occult coronary artery disease (CAD), 28 received coronary angiography, which resulted in 20 revascularizations (17 percutaneous interventions and three bypass surgeries) and eight medical treatments. In patients with significant narrowing, the CACS cutoff value for predicting coronary revascularization was 111.0 (AUC=0.87, 95% confidence interval; 0.76~0.97; sensitivity 80.0%, specificity 92.1%).
According to the NCEP-ATP III guidelines, the prevalence of occult CAD on MDCT was significantly higher in the group with a 10% or higher risk for CHD at 10 years. A CACS≥110 was associated with a significantly higher rate of coronary revascularization in asymptomatic patients with significant stenosis on MDCT. (Korean J Med 78:466-476, 2010)
Keywords: Coronary disease; Tomography, spiral computed; Myocardial revascularization
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