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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Electron-beam tomography coronary calcium scores are superior to Framingham risk variables for predicting the
1Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington 98195, USA. bgbrown@u.washington.edu
Insights
Electron-beam tomography (EBT) coronary calcium scores significantly outperform traditional Framingham risk factors in predicting coronary artery disease (CAD) stenosis burden. EBT calcium scores offer a superior, quantitative measure of disease severity in CAD patients.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Preventive Cardiology
Background:
- Previous studies correlated electron-beam tomography (EBT) coronary calcium scores with visual estimates of coronary artery disease (CAD) severity.
- Coronary artery disease (CAD) management often relies on risk factors and stenosis assessment.
Purpose of the Study:
- To evaluate the predictive capability of EBT-derived coronary calcium scores against traditional Framingham risk variables for stenosis burden in CAD patients.
- To compare the accuracy of Agatston and calcium volume scores with clinical risk factors in quantifying proximal stenosis.
Main Methods:
- Quantitative coronary angiography was used to measure composite proximal stenosis burden in 146 CAD patients.
- EBT-derived Agatston and calcium volume scores were obtained for 115 patients.
- Spearman correlations and multivariate regression analysis were performed to assess relationships between calcium scores, risk variables, and stenosis burden.
Main Results:
- EBT coronary calcium scores (Agatston: r=0.62; calcium volume: r=0.63) showed considerably greater correlation with stenosis burden than Framingham risk factors (e.g., smoking status: r=0.31).
- Multivariate analysis identified calcium score, body mass index, and prior myocardial infarction as independent correlates of stenosis burden (R²=0.45).
- EBT calcium scores were significantly superior to Framingham risk factors in predicting stenosis burden at a given time point.
Conclusions:
- Electron-beam tomography coronary calcium scores are highly effective and superior to traditional risk factors for predicting coronary artery stenosis burden.
- Both Agatston and calcium volume scores derived from EBT are comparably predictive of stenosis burden.
- Quantitative EBT calcium assessment provides a more accurate measure of CAD severity than conventional risk factor assessment.
Abstract:
Previous studies of electron-beam tomography (EBT) have correlated coronary calcium scores with simplistic visual estimates of disease severity. In a clinical trial designed to evaluate 2 treatment strategies in coronary artery disease (CAD) patients with low levels of high-density lipoprotein cholesterol, we used quantitative coronary angiography to measure composite proximal stenosis burden from the baseline coronary angiogram and assessed the traditional Framingham risk variables in 146 patients. Stenosis burden is the sum, per patient, of percent stenosis for the worst lesion found in each of 9 standard proximal coronary segments. EBT estimates of coronary calcium (Agatston score, calcium volume score) were obtained for 115 of these patients. Stenosis burden was correlated with the calcium scores and risk variables. The best traditional correlates of stenosis burden were smoking status (r = 0.31, p = 0.001), prior myocardial infarction (r = 0.24, p = 0.005), body mass index (r = 0.23, p = 0.005), pack-years smoking (r = 0.20, p = 0.05), and age (r = 0.17, p = 0.04). With adjustment for age, all these correlations improved (eg, body mass index x age [r = 0.28, p = 0.001]). In addition, total cholesterol x age (r = 0.22, p = 0.008), fibrinogen x age (r = 0.19, p = 0.03), and systolic blood pressure x age (r = 0.18, p = 0.03) became significant correlates. Spearman correlations of the calcium scores with stenosis burden were considerably greater (Agatston: r = 0.62, p <0.0001; calcium volume: r = 0.63, p <0.0001). In multivariate regression analysis, calcium score, body mass index, and history of myocardial infarction were independent correlates of stenosis burden (R(2) = 0.45). At a given point in time, the EBT coronary calcium scores are greatly superior to the Framingham risk factors in predicting the measured proximal stenosis burden. Agatston and calcium volume scores are comparably predictive of stenosis burden.
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