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Published on: August 28, 2018
Diagnostic Cardiac CT for the Improvement of Cardiovascular Event Prediction
Raimund Erbel1, Nils Lehmann, Sara Schramm
1Institute for Medical Informatics, Biometry and Epidemiology, Essen University Hospital, University of Duisburg-Essen; Department of Neurology, Essen University Hospital, University Duisburg-Essen; Institute for Urban Public Health, Essen University Hospital, University Duisburg-Essen; School of Public Health, Department of Epidemiology, Boston University; Cardioangological Center Bethanien, Frankfurt; Department of Cardiology, Bethanien Hospital Moers, Moers; Grönemeyer Institute, Bochum; Diagnostikum, Mülheim an der Ruhr.
Insights
Adding cardiac computed tomography (CT) to the Atherosclerotic Cardiovascular Disease (ASCVD) score significantly improves cardiovascular event prediction over 20 years. This enhances risk stratification for primary cardiovascular disease prevention.
Area of Science:
- Cardiology
- Medical Imaging
- Preventive Medicine
Background:
- The Heinz Nixdorf Recall Study observed 4355 participants for 20 years to assess cardiovascular event predictability.
- The study compared risk prediction using traditional risk factors versus incorporating cardiac computed tomography (CT).
Purpose of the Study:
- To determine if cardiac CT enhances cardiovascular event prediction compared to using Atherosclerotic Cardiovascular Disease (ASCVD) scores alone.
- To evaluate the long-term impact of CT-based coronary artery calcification (CAC) assessment on risk stratification.
Main Methods:
- Calculated ASCVD scores based on demographic data and cardiovascular risk factors for 4355 individuals (aged 45-75).
- Performed cardiac CT to determine coronary artery calcification (CAC) using the Agatston score.
- Followed participants for a median of 18 years to record cardiovascular events like myocardial infarction or stroke.
Main Results:
- Combining ASCVD score and CAC grade improved risk prediction over ASCVD score alone, even after 20 years.
- Risk category classification improved by 12.2%.
- In high-ASCVD risk individuals, CAC scores of ≥400 were associated with a 34.2% event rate, versus 14% with CAC=0.
Conclusions:
- Cardiac CT, specifically CAC scoring, significantly improves long-term individual cardiovascular risk prediction when added to ASCVD risk factors.
- Cardiac CT should be more widely adopted in primary prevention strategies to complement traditional ASCVD risk assessment.
Background:
The aim of the long-term Heinz Nixdorf Recall Study (observation period 20 years) was to establish the extent to which computed tomography (CT) improves the predictability of cardiovascular events relative to determination of risk factors alone.
Methods:
In the period 2000-2003, study staff examined 4355 probands (53% of them female) aged 45-75 years with no signs of cardiovascular disease. The Atherosclerotic Cardiovascular Disease (ASCVD) score was calculated on the basis of demographic data and cardiovascular risk factors. Cardiac CT was carried out over the same period and coronary artery calcification (CAC) was graded according to the Agatston score.
Results:
The median duration of follow-up was 18.2 years for men and 17.8 years for women. Myocardial infarction or stroke occurred in 458 (11%) of the 4154 participants with complete data. Overall, estimation of risk using a combination of ASCVD score and CAC grade was superior to the ASCVD score alone-even after 10 and 20 years. Classification into established risk categories improved by 12.2% (95% confidence interval: [5.3%; 18.1%]). In the highest ASCVD risk category, we observed occurrence of a cardiovascular event over 20 years for 14% [5.0%; 23.1%] of probands with a CAC score = 0 but for 34.2% [27.5%; 41.4%] of those with a CAC score ≥ 400. In the lowest ASCVD risk category, an event occurred in 2.4% [1.4%; 3.7%] of probands with a CAC score = 0 and in 23.5% [2.3%; 35.8%] of those with a CAC score ≥ 400.
Conclusion:
Even after 20 years, individual risk prediction is improved by addition of CT-based determination of coronary artery calcification to the ASCVD score. Therefore, assessment of ASCVD risk factors should be complemented more widely by cardiac CT in the primary prevention of cardiovascular disease.
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