PO.PR01.05 · 预防研究
作为肺癌筛查项目中偶然发现的冠状动脉粥样硬化
Coronary atherosclerosis as an incidental finding within the lung cancer screening program
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
目的：吸烟是全球可预防的发病和死亡的主要原因，可导致肺癌、COPD、卒中和冠心病。肺癌仍是最致命的恶性肿瘤，吸烟是其主要病因因素。通过低剂量计算机断层扫描（LDCT）进行早期检测可降低死亡率。自2019年以来，苏黎世大学医院开展了一项关于基于LDCT的肺癌筛查（LCS）的全国性可行性研究。由于吸烟也会增加冠状动脉粥样硬化的风险，本研究旨在确定冠状动脉钙化（CAC）作为LCS参与者偶然发现的患病率、严重程度和临床意义，并评估其与年龄和吸烟暴露的关系。
方法：对来自瑞士LCS队列的201名参与者进行了回顾性分析。所有参与者均为符合国家筛查标准的当前或既往重度吸烟者。LDCT扫描由两名胸部放射科医生使用SHEMESH评分进行评估，对LM、LAD、LCx和RCA的钙化程度从0（无）到3（重度）进行分级，CAC总分为0-12。使用广义线性混合模型分析了CAC、年龄和吸烟暴露（包年数）之间的关系。CAC > 4的参与者被建议接受负荷试验，并接受为期四年的随访以进行心脏病学评估或心血管事件监测。
结果：在55.7%（112/201）的参与者中检测到CAC：30.8%为轻度（1-3），15.9%为中度（4-6），8.9%为重度（7-12）。CAC与年龄（p = 0.032）和包年数（p = 0.011）显著相关。在50名CAC > 4的参与者中，一名失访；两名因姑息治疗或非心脏原因死亡而未接受评估；18名正在评估中。八名（19.5%）既往有心脏事件；18名负荷试验阴性。三名（6.3%）试验阳性或有症状，导致进行了血管造影和支架置入；其中两例，接受治疗的血管与CAC评分最高的血管相匹配。大多数钙化位于LAD和RCA。49名中有九名报告有劳力性呼吸困难或非典型胸部不适，促使进一步评估。
结论：偶然发现的CAC在接受LDCT筛查的吸烟者中高度普遍，其严重程度与年龄和累积烟草暴露相关。在LCS期间检测CAC提供了一个在不增加辐射或扫描时间的情况下进行心血管风险评估的机会。将CAC评估整合到LDCT方案中可以增强对高危个体的早期识别，支持预防性心脏病学，并改善结局。本研究支持将LDCT筛查作为对抗肺癌和冠状动脉粥样硬化的双重用途工具，与精准预防医学策略相契合。
查看英文原文 English abstract
Purpose: Smoking is a leading cause of preventable morbidity and mortality worldwide, contributing to lung cancer, COPD, stroke, and coronary heart disease. Lung cancer remains the deadliest malignancy, with smoking as its main etiologic factor. Early detection via low-dose computed tomography (LDCT) reduces mortality. Since 2019, a national feasibility study on LDCT-based lung cancer screening (LCS) has been conducted at University Hospital Zurich. Because smoking also increases coronary atherosclerosis risk, this study aimed to determine the prevalence, severity, and clinical significance of coronary artery calcification (CAC) as an incidental finding in LCS participants and assess its relationship with age and smoking exposure.
Methods: 201 participants from the Swiss LCS cohort were retrospectively analyzed. All were current or former heavy smokers meeting national screening criteria. LDCT scans were assessed by two thoracic radiologists using the SHEMESH score, grading calcification in LM, LAD, LCx, and RCA from 0 (absent) to 3 (severe), with total CAC scores 0-12. Relationships between CAC, age, and smoking exposure (pack-years) were analyzed using a generalized linear mixed model. Participants with CAC > 4 were advised to undergo stress testing and followed for four years for cardiologic evaluation or cardiovascular events.
Results: CAC was detected in 55.7% (112/201): 30.8% mild (1-3), 15.9% moderate (4-6), and 8.9% severe (7-12). CAC correlated significantly with age (p = 0.032) and pack-years (p = 0.011). Among 50 participants with CAC > 4, one was lost to follow-up; two did not undergo evaluation due to palliative care or non-cardiac death; 18 are under assessment. Eight (19.5%) had prior cardiac events; 18 had negative stress tests. Three (6.3%) had positive tests or symptoms, leading to angiography and stent placement; in two cases, the treated vessel matched the highest CAC score. Most calcifications were in LAD and RCA. Nine of 49 reported exertional dyspnea or atypical chest discomfort, prompting further evaluation.
Conclusions: Incidental CAC was highly prevalent in smokers undergoing LDCT screening, with severity linked to age and cumulative tobacco exposure. CAC detection during LCS offers an opportunity for cardiovascular risk assessment without added radiation or scan time. Integrating CAC evaluation into LDCT protocols could enhance early identification of at-risk individuals, support preventive cardiology, and improve outcomes. This study supports LDCT screening as a dual-purpose tool against lung cancer and coronary atherosclerosis, aligning with precision preventive medicine strategies.
利益披露 Disclosure
E. Sostero, None..
K. Chiffi, None..
L. Jungblut, None..
V. Englmaier, None..
T. Frauenfelder, None..
S. Hillinger, None.