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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary computed tomography angiography-based coronary risk stratification in subjects presenting with no or
Shinichiro Fujimoto1, Takeshi Kondo, Takahide Kodama
1Department of Cardiology, Takase Clinic, 885-2 Minami-orui, Takasaki 370-0036, Japan. s-fujimo@tj8.so-net.ne.jp
Insights
Coronary CTA identifies high-risk plaque in asymptomatic patients with intermediate or higher risk. Male sex, diabetes mellitus, and smoking predict vulnerable plaque, aiding risk re-stratification.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Coronary computed tomography angiography (CTA) can identify high-risk plaque features like positive vessel remodeling and low-attenuation plaque (CT-HRP).
- CT-HRP is associated with an increased risk of acute coronary syndromes.
- The study aimed to evaluate coronary CTA's utility in re-stratifying risk for patients with asymptomatic or atypical chest symptoms.
Purpose of the Study:
- To assess the role of coronary CTA in refining cardiovascular risk assessment.
- To identify predictors of CT-HRP in patients with intermediate to high pre-test risk.
- To determine if CTA findings add value beyond traditional risk scores.
Main Methods:
- 1,139 asymptomatic or atypical chest symptom patients underwent coronary CTA and Agatston scoring.
- Logistic regression analysis identified predictors of CT-HRP.
- Patients were stratified by Framingham Risk Scores (FRS).
Main Results:
- CT-HRP was found in 6.3% of subjects.
- Prevalence of CT-HRP increased with FRS: 0% (low), 4.3% (intermediate), 15.5% (high).
- Independent predictors of CT-HRP in intermediate/high-risk groups were male sex, diabetes mellitus (DM), and current smoking.
Conclusions:
- Coronary CTA is valuable for risk re-stratification in asymptomatic or atypical chest pain patients with intermediate or higher risk.
- Male sex, DM, and smoking are independent predictors of vulnerable plaque in this population.
- CTA findings can enhance traditional risk assessment tools like FRS.
Background:
Coronary computed tomography angiography (CTA) findings of positive vessel remodeling and low-attenuation plaque, referred to as computed tomography-verified high-risk plaque (CT-HRP), have been reported to be associated with the development of subsequent acute coronary syndromes. The aim of this study was to examine the usefulness of coronary CTA for coronary risk re-stratification of patients with asymptomatic and atypical chest symptoms.
Methods And Results:
A total of 1,139 subjects (M/F 602/537; mean age, 61.5±9.3 years) who were either asymptomatic or presented with atypical chest symptoms underwent coronary 64- or 320-slice multidetector computed tomography angiography and Agatston score. Age, sex, coronary risk factors, including hypertension, diabetes mellitus (DM), dyslipidemia, and smoking were investigated as predictors for CT-HRP on multivariate analysis using logistic regression analysis. CT-HRP was observed in 72 patients (6.3%). Based on Framingham risk scores (FRS), CT-HRP was observed in 0/94 subjects (0.0%) in the low-risk group, 35/806 (4.3%) in the intermediate-risk group, and 37/239 (15.5%) in the high-risk group. On logistic regression analysis significant predictors for CT-HRP in intermediate- and high-risk subjects were male sex (odds ratio [OR] 2.829; 95% confidence interval [CI] 1.460-5.479, P=0.0021), DM (OR 2.418; 95% CI 1.420-4.116, P=0.0011), and current smoking (OR 1.922; 95% CI 1.096-3.371, P=0.0160). CT-HRP prevalence for Agatston scores >500 and >250 was lower in the intermediate- and high-risk groups, respectively.
Conclusions:
In asymptomatic subjects and those presenting with atypical chest pain who have a more than an intermediate risk, coronary CTA is contributory to FRS. Male sex, DM and smoking were independent predictors of vulnerable plaque in the more than intermediate-risk group.
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