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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary Artery Calcium Score Predicts Major Adverse Cardiovascular Events in Stable Chest Pain
Federico Biavati1, Luca Saba1, Melinda Boussoussou1
1From the Department of Radiology (F.B., E.Z., A.E.N., R. Haase, S.F., M. Mohamed, M.R., V.W., M.E., M. Bosserdt, M.D.), Institute of Public Health (N.R.), Institute of Biometry and Clinical Epidemiology (K.N.), and Department of Cardiology and Angiology (H.D.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Radiology, University of Cagliari, Cagliari, Italy (L.S., R.C.); Heart and Vascular Center (M. Boussoussou, P.M.H., B.M., B.S., I.F.É.) and Department of Radiology, Medical Imaging Center (P.M.H.), Semmelweis University, Budapest, Hungary; Departments of Cardiology (K.F.K., P.E.S.) and Radiology (K.F.K., P.E.S.), Copenhagen University Hospital-Rigshospitalet and Department of Clinical Medicine (J.D.H.), Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Internal Medicine, Clinic of Cardiology (T.B., R. Hodas), and Department of Cardiology (R.A.), George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania; County Clinical Emergency Hospital Targu Mures, Targu Mures, Romania (T.B.); Department of Cardiology, Southeastern Health and Social Care Trust, Belfast, United Kingdom (P.D., C.O., S.K., S.R.); Departments of Cardiology (J.R.P., F.X.V., B.G.d.B.) and Radiology (H.C.C.), Hospital Universitario Vall d'Hebron, Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red, Madrid, Spain (J.R.P., F.X.V., B.G.d.B.); Departments of Cardiology (A.E.) and Radiology (L.Z.), Paul Stradins Clinical University Hospital, Riga, Latvia; University of Latvia, Riga, Latvia (A.E.); Departments of Cardiology (C.Š.) and Imaging Methods (V.S.), Motol University Hospital, Prague, Czech Republic; Department of Cardiology, Medical Academy (G.Š.), and Department of Radiology (A.J.), Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia (N.Č.A., F.A.); Department of Cardiology, Institute for Cardiovascular Diseases of Vojvodina, Novi Sad, Serbia (N.Č.A., F.A.); Departments of Radiology (M.G.) and Cardiology (M.W.), University of Leipzig Heart Centre, Leipzig, Germany; Departments of Radiology (J.D.D.) and Cardiology (D.C.), St. Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland (J.D.D.); Departments of Cardiology (I.D., A.R.) and Radiology (I.L.), Basurto Hospital, Bilbao, Spain; Departments of Cardiology (G.D.) and Radiology (E.T.), Aintree University Hospital, Liverpool, United Kingdom; Edge Hill University, Ormskirk, United Kingdom (G.D.); National Institute of Cardiology, Warsaw, Poland (C. Kępka, M.K.); Department of Cardiology, Internal Medicine Clinic, Clinical Hospital Center Zemun, and Faculty of Medicine, University of Belgrade, Belgrade, Serbia (R.V., A.N.N.); Department of Radiological, Oncological and Pathological Sciences (M. Francone) and Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences (M. Mancone), Sapienza University of Rome, Rome, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy (M. Francone); Departments of Cardiology (M.I.S.) and Radiology (D.K.), Provincial Specialist Hospital in Wroclaw, Wroclaw, Poland; Departments of Internal Medicine III (F.P.), Cardiology (F.P.), and Radiology (G.F.), Innsbruck Medical University, Innsbruck, Austria; Turku PET Centre (J.K.) and Heart Center (M.P.), Turku University Hospital and University of Turku, Turku, Finland; Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia-Espinho, Vila Nova de Gaia, Portugal (R.F., V.G.R.); Department of Cardiology, Alb Fils Kliniken, Göppingen, Germany (S.S., T.D.); School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom (C.B., C.D.); Golden Jubilee National Hospital, Clydebank, United Kingdom (C.B.); Department of Cardiology, Liverpool University Hospital NHS FT, Liverpool, United Kingdom (B.R., M. Fisher); Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (B.R., M. Fisher); European Clinical Research Infrastructure Network-European Research Infrastructure Consortium (ECRIN-ERIC), Paris, France (C. Kubiak); Department of Public Health, Section for Health Services Research, University of Copenhagen, Copenhagen, Denmark (K.S.H.); Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Munich, Germany (J.M.N.); Center of Advanced Research in Multimodality Cardiac Imaging, CardioMed Medical Center, Targu Mures, Romania (I.B., I.R.); Administrative Centre, Health Care District of Southwestern Finland, Turku, Finland (M.P.); Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom (M. Fisher); Department of Cardiology, Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark (C. Kragelund); Department of Cardiology, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark (J.D.H.); Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark (L.L.); DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany (M. Mohamed, M.D.); Department of Clinical Epidemiology and Applied Biostatistics, Universitätsklinikum Tübingen, Tübingen, Germany (L.M.S.H., P.M.); Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany (H.D., M.D.); Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Berlin, Germany (H.D.); Department of Cardiology, Lundquist Institute at Harbor-UCLA, Torrance, Calif (M.J.B.); Berlin Institute of Health, Berlin, Germany (M.D.); and Berlin University Alliance, Berlin, Germany (M.D.).
Coronary artery calcium (CAC) scoring effectively predicts major adverse cardiovascular events (MACE) in patients with stable chest pain. A CAC score of 0 indicates a very low risk, while higher scores correlate with increased MACE risk.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Preventive Medicine
Background:
- Coronary artery calcium (CAC) scoring is established for risk stratification in asymptomatic individuals.
- The prognostic utility of CAC scoring in symptomatic patients, particularly those with stable chest pain, requires further clarification.
- Current guidelines recommend invasive coronary angiography (ICA) for symptomatic patients, but its role alongside CAC scoring is debated.
Purpose of the Study:
- To evaluate the prognostic value of CAC scoring for major adverse cardiovascular events (MACE) in patients with stable chest pain.
- To assess the association between CAC scores and the prevalence of obstructive coronary artery disease (CAD) and need for revascularization.
- To compare MACE risk across different CAC score categories in this patient cohort.
Main Methods:
- Subgroup analysis of the DISCHARGE trial involving 1749 adult patients with stable chest pain referred for ICA.
- Participants were randomized to ICA or coronary CT; CAC scores were categorized as low (0), intermediate (1-399), and high (≥400).
- MACE (myocardial infarction, stroke, cardiovascular death) were tracked over a median 3.5-year follow-up using Cox regression.
Main Results:
- Obstructive CAD prevalence increased significantly with higher CAC scores, from 4.1% (CAC=0) to 76.1% (CAC≥400).
- Revascularization rates also escalated with CAC scores, from 1.7% to 46.2% across the same groups (P < .001).
- MACE risk was lowest with CAC=0 (0.5%) and highest with CAC≥400 (6.8%), with intermediate risk for CAC 1-399 (1.9%).
Conclusions:
- In symptomatic patients with stable chest pain referred for ICA, CAC scoring provides significant prognostic information.
- A CAC score of 0 is associated with a very low risk of MACE, suggesting potential for non-invasive management.
- Higher CAC scores correlate with increased likelihood of obstructive CAD, need for revascularization, and future MACE.
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