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Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
Published on: September 22, 2023
Coronary computed tomography angiography and calcium scoring in routine clinical practice for identification of
Grazina Urbonaviciene1, Christin Isaksen2, Sigitas Urbonavicius3
1University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark; Aarhus University, Institute for Clinical Medicine, Aarhus, Denmark.
Insights
Coronary computed tomography angiography (CCTA) shows high predictive value for coronary artery disease. However, adding coronary artery calcium score (CACS) to risk factors did not improve identifying patients needing revascularization.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Preventive Cardiology
Background:
- Coronary computed tomography angiography (CCTA) is highly effective in predicting coronary artery disease (CAD), especially when coronary calcification is absent.
- The combined utility of CCTA, coronary artery calcium score (CACS), and traditional risk factors for determining coronary revascularization indications remains understudied.
Purpose of the Study:
- To evaluate the role of coronary artery calcium score (CACS) in predicting the need for coronary revascularization after CCTA.
- To assess if combining CACS with CCTA and conventional risk factors improves revascularization risk prediction.
Main Methods:
- A study of 2302 patients without known CAD who underwent 320-row CCTA.
- Logistic regression, c-statistic, and net reclassification improvement (NRI) were used to analyze the predictive value of CACS for revascularization.
Main Results:
- Revascularization rates increased significantly with higher CACS categories, from 0.75% (CACS=0) to 42.4% (CACS≥1000).
- The area under the ROC curve (AUC) for revascularization prediction was 0.85. Adding CACS improved risk prediction accuracy (AUC 0.74 vs 0.63, P=0.001).
- However, CACS did not substantially reclassify patients into different risk categories for revascularization (NRI=-0.023, P=0.66).
Conclusions:
- 320-row CCTA can effectively rule out CAD in low- to intermediate-risk individuals.
- The accuracy of CCTA alone in identifying patients who require revascularization is limited.
- Incorporating CACS into conventional risk factors did not enhance the identification of patients needing revascularization.
Background:
The predictive value of CCTA to predict coronary artery disease is high in particular in the absence of coronary calcification. However, the consideration of both CCTA and the calcium score, in addition to the risk factors to determine the indication for coronary revascularization, has not been yet studied.
Materials And Methods:
This study included 2302 patients (mean age: 60±9.8 years, 46% men), without known coronary artery disease (CAD), who underwent 320-row CCTA. Logistic regression, c-statistic and net reclassification improvement (NRI) were used to assess the role of coronary artery calcium score (CACS) in predicting revascularization after CCTA.
Results:
The revascularization rates were 0.75% in patients with a CACS of 0, and there were no adverse events during the follow-up period. The revascularization rates were 3.3% in patients with a CACS of 1-99, 15.4% in patients with a CACS of 100-399, 25.6% in patients with a CACS of 400-999, and 42.4% in patients with a CACS≥1000. The crude and adjusted odds ratios (95% confidence interval) for revascularization per CACS group category were 2.89 (2.53-2.3) and 2.71 (2.33-3.15), respectively; the area under the ROC curve (AUC) was 0.85 (0.83-0.88). The addition of CACS to conventional risk factors improved the accuracy of risk prediction model for revascularization (AUC 0.74 vs 0.63, P=0.001), but it did not reclassify a substantial proportion of patients with positive CACS to risk categories (NRI=-0.023, P=0.66).
Conclusions:
The 320-row CCTA might rule out CAD in low- to intermediate-risk patients. However, its accuracy in identifying patients who require revascularization is limited. The CACS added to the conventional risk factors did not improve the identification of patients who require revascularization.
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