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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Prognostic Value of Coronary Computed Tomography (CT) Angiography and Coronary Artery Calcium Score Performed Before
Shinichiro Fujimoto1, Takeshi Kondo2, Kanako K Kumamaru3
1Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan (S.F., K.T., Y.K., R.M., M.H., K.M., H.D.) Department of Cardiology, Takase Clinic, Takasaki, Japan (S.F., T.K., K.T.).
Insights
Coronary artery calcium score (CACS) and high-risk plaque detected by CT angiography before revascularization predict future cardiac events. These imaging findings improve risk prediction for patients undergoing revascularization procedures.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Cardiac events post-revascularization stem from lesion recurrence and new nonculprit lesions.
- Predicting these events is crucial for patient management.
Purpose of the Study:
- To test if coronary CT angiography and coronary artery calcium score (CACS) before revascularization predict cardiac events.
- To assess the predictive value of CACS and CT-verified high-risk plaque (CT-HRP).
Main Methods:
- 2238 patients without prior CAD underwent coronary CT angiography and CACS.
- 359 patients underwent revascularization; 337 had follow-up data.
- Cox proportional hazard models analyzed predictors of cardiac events.
Main Results:
- Age, diabetes, triglycerides, CACS, and nonculprit CT-HRP were significant predictors.
- Models including CACS and CT-HRP showed improved, though not statistically significant, discriminatory power for cardiac events.
- CACS alone had a C-statistic of 63.2%; CACS + CT-HRP had 65.8%.
Conclusions:
- High CACS and nonculprit CT-HRP identified before revascularization significantly predict subsequent cardiac events.
- These CT-derived metrics enhance risk stratification in patients undergoing revascularization.
Background:
Cardiac events after revascularization are equally attributable to recurrence at site of culprit lesions and development of nonculprit lesions. We evaluated the hypothesis that coronary computed tomography (CT) angiography and coronary artery calcium score (CACS) performed before revascularization predicts cardiac events after treatment.
Methods And Results:
Among 2238 consecutive patients without known coronary artery disease who underwent coronary CT angiography and CACS, 359 patients underwent revascularization within 30 days after CT; in 337 of 359 (93.9%) follow-up clinical information was available. In addition to known cardiac risk factors, CT findings were evaluated as predictors of cardiac events after revascularization: CACS and the presence of CT-verified high-risk plaque (CT-HRP). Improvement of predictive accuracy by including CT findings was evaluated from a discrimination (Harrell's C-statistics) standpoint. During the follow-up period (median: 673, interquartile range: 47 to 1529 days), a total of 98 cardiac events occurred. Cox proportional hazard model revealed that age, diabetes, triglyceride, CACS, and nonculprit CT-HRP were significant predictors of overall cardiac events. Although not statistically significant, discriminatory power was greater for the model with CACS (C-stat: 63.2%) and the model with both CACS and CT-HRP (65.8%) compared to the model including neither CACS nor CT-HRP (60.7%).
Conclusions:
High CACS and the presence of nonculprit CT-HRP performed before revascularization are significant predictors of cardiac events after revascularization.
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An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...