冠脉积分在心肌梗死风险评估与预后中的研究进展：现状与展望

Research Advances in Coronary Artery Scoring for Myocardial Infarction Risk Assessment and Prognosis: Current Status and Future Perspectives

摘要: 冠状动脉粥样硬化性心脏病(冠心病)是全球范围内致死和致残的主要原因，精准的心血管风险分层对于心肌梗死的一级预防和二级预防均具有重要的临床意义。冠状动脉积分是通过影像学手段对冠脉粥样硬化斑块负荷进行量化评估的工具，在心肌梗死(MI)的风险分层与预后预测中发挥着日益重要的作用。作为量化冠状动脉粥样硬化负荷的核心手段，冠脉积分系统经历了从传统解剖学评分到整合炎症、代谢及人工智能等多维度信息的深刻演进。本文系统梳理了以冠状动脉钙化积分(CACS)、Gensini评分、SYNTAX评分、Leiden评分、CatLet评分、segment involvement score (SIS)、CaRi-Heart^®炎症风险评分以及新型CAC-DAD评分等为代表的冠脉积分工具在心肌梗死研究中的应用现状，重点阐释了不同评分体系的临床价值、局限性以及近年来在个体化医疗中的进展趋势。总体而言，单次CACS在无症状中危人群中的风险分层效能已获充分验证，新的研究则进一步揭示了CACS进展与钙化亚组表型的预后意义；残余SYNTAX评分和高敏炎症积分等工具正在改变心肌梗死患者的血运重建后管理策略；以CaRi-Heart^®为代表的人工智能驱动炎症评分和心外膜脂肪放射性组学技术正在突破传统解剖学评分的瓶颈，提供炎症驱动的预测信息；新型CAC-DAD评分较传统Agatston评分可识别更多MACE事件(74% vs 57%)；未来冠脉积分的发展方向将是多模态数据融合、动态纵向建模以及人工智能赋能的精准风险画像，推动心血管疾病预防与治疗向更高水平的个体化和智能化迈进。

Abstract: Coronary atherosclerotic heart disease (coronary artery disease) remains a leading cause of mortality and disability worldwide. Accurate cardiovascular risk stratification is of paramount clinical importance for both primary and secondary prevention of myocardial infarction (MI). Coronary artery scoring, which quantifies the atherosclerotic plaque burden via imaging modalities, has emerged as an increasingly valuable tool in risk stratification and prognostic prediction for MI. As a core means of quantifying coronary atherosclerotic burden, the coronary scoring system has undergone a profound evolution—from traditional anatomical scoring to multidimensional integration of inflammatory, metabolic, and artificial intelligence (AI)-derived information. This review systematically summarizes the current application status of representative coronary scoring tools in MI research, including the coronary artery calcium score (CACS), Gensini score, SYNTAX score, Leiden score, CatLet score, segment involvement score (SIS), CaRi-Heart^® inflammatory risk score, and the novel CAC-DAD score. We focus on delineating the clinical value, limitations, and recent advances toward personalized medicine for each scoring system. Overall, the risk-stratification efficacy of a single CACS measurement in asymptomatic intermediate-risk populations has been well validated, while emerging studies further reveal the prognostic significance of CACS progression and calcified subtype phenotypes. Tools such as the residual SYNTAX score and high-sensitivity inflammatory scores are reshaping post-revascularization management strategies in MI patients. AI-driven inflammatory risk scores, represented by CaRi-Heart^®, and epicardial adipose tissue radiomics are breaking through the constraints of traditional anatomical scores by providing inflammation-driven predictive information. The novel CAC-DAD score identifies a higher proportion of major adverse cardiovascular events (MACE) compared with the conventional Agatston score (74% vs. 57%). Future directions for coronary scoring lie in multimodal data fusion, dynamic longitudinal modeling, and AI-powered precision risk profiling, driving cardiovascular disease prevention and treatment toward higher levels of individualization and intelligence.