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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Nonobstructive Coronary Artery Disease by Coronary CT Angiography Improves Risk Stratification and Allocation of
Hamed Emami1, Richard A P Takx2, Thomas Mayrhofer3
1Cardiac MR PET CT Program, Division of Cardiovascular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Internal Medicine, Yale-New Haven Hospital, Yale Medical School, New Haven, Connecticut.
Insights
Nonobstructive coronary artery disease (CAD) significantly increases risk for atherosclerotic cardiovascular disease (ASCVD) events. Incorporating this finding into risk calculators can improve statin therapy recommendations for patients.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Nonobstructive coronary artery disease (CAD) detected via coronary computed tomography angiography may enhance risk stratification.
- Improved risk assessment can lead to more personalized statin therapy allocation.
Purpose of the Study:
- To evaluate the prognostic value of nonobstructive CAD for atherosclerotic cardiovascular disease (ASCVD) events.
- To determine if including nonobstructive CAD data in the pooled cohort equation reclassifies statin therapy recommendations per 2013 ACC/AHA guidelines.
Main Methods:
- Determined the pooled hazard ratio for ASCVD events associated with nonobstructive CAD from published studies.
- Integrated this hazard ratio into the ACC/AHA pooled cohort equation to recalculate 10-year ASCVD risk.
- Assessed statin eligibility reclassification in a separate patient cohort using meta-analysis results.
Main Results:
- Nonobstructive CAD showed a hazard ratio of 3.2 for ASCVD events (95% CI: 1.5–6.7).
- Inclusion of nonobstructive CAD led to reclassification toward statin eligibility for many individuals across sex and ethnicity groups.
- Absence of nonobstructive CAD resulted in reclassification toward statin ineligibility for others.
Conclusions:
- Coronary computed tomography angiography detection of nonobstructive CAD improves risk stratification.
- This information enables more individualized and appropriate statin therapy allocation across diverse patient groups.
Objectives:
This study sought to determine prognostic value of nonobstructive coronary artery disease (CAD) for atherosclerotic cardiovascular disease (ASCVD) events and to determine whether incorporation of this information into the pooled cohort equation reclassifies recommendations for statin therapy as defined by the 2013 guidelines for cholesterol management of the American College of Cardiology and American Heart Association (ACC/AHA).
Background:
Detection of nonobstructive CAD by coronary computed tomography angiography may improve risk stratification and permit individualized and more appropriate allocation of statin therapy.
Methods:
This study determined the pooled hazard ratio of nonobstructive CAD for ASCVD events from published studies and incorporated this information into the ACC/AHA pooled cohort equation. The study calculated revised sex- and ethnicity-based 10-year ASCVD risk and determined boundaries corresponding to the original 7.5% risk for ASCVD events. It also assessed reclassification for statin eligibility by incorporating the results from meta-analysis to individual patients from a separate cohort.
Results:
This study included 2 studies (2,295 subjects; 66% male; prevalence of nonobstructive CAD, 47%; median follow-up, 49 months; 67 ASCVD events). The hazard ratio of nonobstructive CAD for ASCVD events was 3.2 (95% confidence interval: 1.5 to 6.7). Incorporation of this information into the pooled cohort equation resulted in reclassification toward statin eligibility in individuals with nonobstructive CAD, with an original ASCVD score of 3.0% and 5.9% or higher in African-American women and men and a score of 4.4% and 4.6% or higher in Caucasian women and men, respectively. The absence of nonobstructive CAD resulted in reclassification toward statin ineligibility if the original ASCVD score was as 10.0% and 17.9% or lower in African-American women and men and 13.7% and 14.3% or lower in Caucasian women and men, respectively. Reclassification is observed in 14% of patients.
Conclusions:
Detection of nonobstructive CAD by coronary computed tomography angiography improves risk stratification and permits individualized and more appropriate allocation of statin therapy across sex and ethnicity groups.
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