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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Evaluation of coronary artery calcium score by age and sex: a multicenter study
Muhammed Tekinhatun1, Fatma Durmaz2
1Department of Radiology, Dicle University Faculty of Medicine, Diyarbakir, Turkey. mtekinhatun@gmail.com.
Insights
Coronary artery calcium (CAC) scores are better understood using percentile-based interpretation and coronary age estimation, especially for low-risk individuals. This approach offers a more personalized risk assessment than absolute CAC scores alone.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Coronary artery calcium (CAC) scoring is crucial for cardiovascular risk assessment.
- Traditional risk factors influence CAC scores, but interpretation can be challenging, especially in diverse populations.
- Standardized reporting systems like CAD-RADS aim to classify plaque burden, but their agreement with percentile-based risk stratification needs evaluation.
Purpose of the Study:
- To establish age- and sex-specific percentile reference values for CAC scores in a large Turkish cohort.
- To evaluate the agreement between CAD-RADS plaque burden scores and a percentile-based CAC classification system.
- To assess the utility of percentile-based CAC interpretation and coronary age estimation for individualized risk assessment.
Main Methods:
- Retrospective analysis of 4,887 patients undergoing coronary CT angiography (CCTA) with non-contrast imaging.
- Calculation of CAC scores using the Agatston method and generation of age-, sex-, and risk factor-specific percentile curves.
- Estimation of "coronary age" and assessment of agreement between CAD-RADS plaque burden (P) scores and percentile-based CAC classification using Cohen's kappa.
Main Results:
- Higher CAC scores were significantly associated with age, male sex, and traditional cardiovascular risk factors (hypertension, diabetes, hyperlipidemia, smoking) (p < 0.01).
- Each additional risk factor increased the likelihood of having detectable CAC (CAC > 0).
- A significant proportion (22.3%) of low-to-intermediate risk individuals had CAC scores above the 75th percentile, and agreement between CAD-RADS P scores and percentile-based classification was poor (κ = 0.12, p < 0.01).
Conclusions:
- Absolute CAC scores may not accurately reflect relative cardiovascular risk in younger or low-risk individuals.
- Percentile-based interpretation of CAC scores provides a more individualized risk assessment, particularly beneficial for low-to-intermediate risk populations.
- Coronary age estimation, derived from percentile data, offers a valuable tool for personalized cardiovascular risk stratification.
Purpose:
To evaluate coronary artery calcium (CAC) scores in a large Turkish cohort using age- and sex-specific percentiles, and to assess the agreement between CAD-RADS plaque burden scores and percentile-based CAC classification.
Methods:
A total of 4,887 clinically referred patients who underwent coronary CT angiography (CCTA) with non-contrast imaging were retrospectively evaluated. CAC scores were calculated using the Agatston method. Percentile reference values were generated according to age, sex, and number of cardiovascular risk factors. "Coronary age" was estimated by matching each individual's CAC score to the 50th percentile value. The agreement between CAD-RADS P scores and percentile-based classification was assessed using Cohen's kappa.
Results:
Age, male sex, and traditional risk factors (hypertension, diabetes, hyperlipidemia, and smoking) were significantly associated with higher CAC scores (p < 0.01). The likelihood of CAC > 0 increased with each additional risk factor. Among individuals with low to intermediate cardiovascular risk, 22.3% had CAC scores above the 75th percentile. ROC analysis showed strong discriminatory ability for risk factor-based prediction of CAC > 0 (AUC = 0.873). However, agreement between CAD-RADS P scores and percentile-based classification was poor (κ = 0.12, p < 0.01).
Conclusion:
Absolute CAC scores do not reliably reflect relative risk in younger or low-risk individuals. Percentile-based interpretation and coronary age estimation offer a more individualized approach, particularly valuable in low-to-intermediate risk populations.
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