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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Added value of CAC in risk stratification for cardiovascular events: a systematic review
Sanne A E Peters1, Marina Bakker, Hester M den Ruijter
1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. s.a.e.peters@umcutrecht.nl
Insights
Coronary artery calcification (CAC) scoring improves cardiovascular disease (CVD) risk prediction, especially for intermediate-risk individuals. This atherosclerosis marker helps reclassify patients into more accurate risk categories, aiding treatment decisions.
Area of Science:
- Cardiovascular medicine
- Medical imaging
- Risk assessment
Background:
- Accurate cardiovascular disease (CVD) risk prediction is crucial for timely treatment and prevention.
- Current risk models have limitations in accurately assessing individual CVD risk.
- Novel markers are needed to enhance risk stratification.
Purpose of the Study:
- To systematically review the added value of coronary artery calcification (CAC) in predicting CVD risk.
- To evaluate CAC's impact on risk reclassification in asymptomatic individuals.
Main Methods:
- Systematic review of PubMed publications up to February 1, 2011.
- Focused on studies assessing CAC in asymptomatic individuals.
- Analyzed the impact of CAC on risk prediction models.
Main Results:
- Nine studies in asymptomatic individuals were included.
- CAC addition increased the area under the curve (0.05–0.20) in risk models.
- CAC improved risk category reclassification by 14%–30%, particularly in intermediate-risk groups.
Conclusions:
- Coronary artery calcification scoring enhances CVD risk stratification when combined with traditional factors.
- The benefit is most significant for individuals at intermediate CVD risk.
- Further cost-effectiveness and clinical trials are needed for widespread adoption.
Background:
Identification of individuals at high risk for cardiovascular disease (CVD) is important to initiate adequate treatment and to prevent future events. Moreover, identification of low-risk individuals is important to refrain from unneeded therapy. Current risk prediction models do not accurately predict the risk of CVD in individuals, and new markers have been sought to improve the risk assessment in individuals. Coronary artery calcification (CAC) is a marker of atherosclerosis that might improve current risk assessment when added to traditional risk factors.
Materials And Methods:
We performed a systematic review on PubMed search (1 February 2011) on studies reporting on the added value of CAC in risk prediction in asymptomatic individuals.
Results:
Of 39 publications on CAC and CVD, nine studies were carried out in asymptomatic individuals. All studies showed an increase in area under the curve ranging from 0.05 to 0.20 when CAC was added to the risk model. Four studies reported on improvements of individuals in low-, intermediate-, and high-risk categories. Addition of CAC to the risk model resulted in a net reclassification improvement ranging from 14% to 30%, meaning that CAC measurement reclassified a substantial proportion of individuals into correct risk categories. This improvement was most pronounced in those at intermediate Framingham risk.
Conclusions:
The available studies consistently showed that CAC scoring improves risk stratification in CVD risk categories when added to traditional risk factors only, especially among individuals at intermediate risk for CVD. Cost-effectiveness analyses together with a randomized controlled trial are needed before widespread introduction of CAC in clinical care.
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