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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Impact of Zero Coronary Artery Calcium Scoring on Downstream Cardiac Testing and Cardiac Outcomes Compared With No
Ethan Lin1,2, Rea Alonzo2, Jiming Fang2
1Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Insights
Zero coronary artery calcium (CAC) scoring in patients without prior cardiovascular disease is linked to fewer invasive procedures and a significantly lower risk of myocardial infarction. This finding supports using zero CAC to guide cardiovascular care decisions.
Area of Science:
- Cardiology
- Medical Imaging
- Preventive Medicine
Background:
- The clinical impact of coronary artery calcium (CAC) scoring, particularly in individuals with a zero CAC score, requires further clarification regarding downstream healthcare resource utilization and patient outcomes.
- Understanding the implications of zero CAC is crucial for refining risk stratification and guiding clinical decision-making in cardiovascular disease prevention.
Purpose of the Study:
- To evaluate the downstream resource utilization and clinical outcomes in patients with a zero CAC score compared to a propensity score-matched control group without CAC testing.
- To assess the association of zero CAC with subsequent cardiac testing, interventions, and major adverse cardiovascular events.
Main Methods:
- A retrospective analysis linked CAC scores from two academic hospitals in Toronto to population-based databases.
- Patients with zero CAC and no prior cardiovascular disease were propensity score matched with a control group based on age, sex, cardiovascular risk factors, and comorbidities.
- Downstream outcomes including cardiac testing, myocardial infarction, heart failure hospitalizations, and emergency department visits were compared between the groups.
Main Results:
- In a cohort of 4884 patients (2709 with zero CAC), higher rates of graded-stress testing, stress echocardiography, and cardiac MRI were observed in the zero CAC group.
- Rates of myocardial perfusion scintigraphy and catheterization were similar, while percutaneous coronary intervention and coronary artery bypass grafting were lower in the zero CAC group.
- The zero CAC group experienced a significantly lower rate of myocardial infarction (approximately 5-fold reduction) but showed no significant difference in heart failure hospitalizations or emergency department admissions.
Conclusions:
- The findings support the utility of a zero CAC score in identifying patients who may benefit from reduced interventional cardiovascular procedures.
- A zero CAC score is associated with favorable downstream cardiovascular events, including a substantially lower risk of myocardial infarction.
- Zero CAC can be a valuable tool for de-intensifying care and avoiding unnecessary invasive procedures in asymptomatic individuals.
Background:
The impact of coronary artery calcium (CAC) scoring on downstream resource utilisation and outcomes remains unclear, especially in those with zero CAC.
Methods:
Consecutive CAC scores from two academic hospitals in Toronto, Ontario, were linked to population-based databases. Subjects with zero CAC without previous cardiovascular disease were propensity score matched with a non-CAC-tested control group for age, sex, cardiovascular risk factors, and comorbidities. Downstream cardiac testing, acute myocardial infarction, heart failure (HF) hospitalisations, and HF emergency department (ED) visits were compared between the 2 groups.
Results:
A total of 4884 patients underwent CAC scoring, of whom 2709 had zero CAC (mean 52.9 ± 10.6 years), 55.4% women. At 3.4 years, graded-stress testing (hazard ratio [HR] 1.24, 95% confidence interval [95% CI] 1.14-1.35), stress echocardiography (HR 1.80, 95% CI 1.59-2.05), and cardiac magnetic resonance imaging (HR 3.40, 95% CI 2.55-4.53) use was higher in the zero CAC group, whereas myocardial perfusion scintigraphy (HR 1.08, 95% CI 0.97-1.21) and catheterisation (HR 1.14, 95% CI 0.91-1.44) were similar and percutaneous coronary intervention (HR 0.58, 95% CI 0.35-0.98) and coronary artery bypass grafting (HR 0.14, 95% CI 0.03-0.61) were lower. There was an approximately 5-fold lower rate of myocardial infarction (HR 0.22, 95% CI 0.10-0.51) in the zero CAC group and no difference in HF hospitalisations (HR 1.15, CI 95% 0.53-2.48) or ED admissions (HR 1.21, 95% CI 0.58-2.52).
Conclusions:
Our results support the utility of zero CAC in limiting interventional cardiovascular procedures while maintaining an association with reduced downstream cardiovascular events.
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