Does coronary calcium scoring with a SCORE better predict significant coronary artery stenosis than without?...

Area of Science:

• Cardiology
• Radiology
• Preventive Medicine

Background:

• Coronary artery disease (CAD) remains a leading cause of mortality.
• Accurate risk stratification is crucial for timely intervention.
• Computed tomography coronary angiography (CTCA) is a gold standard for assessing coronary artery stenosis.

Purpose of the Study:

• To evaluate the effectiveness of coronary artery calcium score (CACS) alone and combined with Systematic Coronary Risk Evaluation (SCORE) for detecting significant coronary artery stenosis.
• To compare the predictive performance of CACS and SCORE using CTCA as the reference standard.
• To determine the optimal use of CACS and SCORE in risk stratification for coronary artery disease.

Main Methods:

• A cohort of 2021 patients with suspected CAD underwent both CACS testing and CTCA.
• Patients were analyzed based on age, gender, CACS, and estimated SCORE risk.
• Sensitivity, specificity, and Receiver Operating Characteristic (ROC) curves were employed to assess diagnostic performance.

Main Results:

• CACS demonstrated superior predictive value for critical stenosis compared to SCORE alone in logistic regression and ROC analysis.
• The highest predictive accuracy for CACS was observed in patients aged 50-59 years.
• Combining CACS with SCORE identified a higher prevalence of significant stenosis (7.0%) in patients with zero CACS and high SCORE risk, while identifying a lower prevalence (0.9%) in those with low SCORE risk.

Conclusions:

• The combination of CACS and SCORE effectively predicts coronary artery stenosis.
• In patients with a zero CACS, CTCA is recommended for those with high or very high SCORE risk to further assess for significant stenosis.
• This combined approach aids in refining risk stratification and guiding further diagnostic imaging in suspected coronary artery disease.