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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Assessing Coronary Calcium Thresholds on Attenuation-Correction CT With Myocardial Perfusion Imaging Equating to
Ioannis Kyriakoulis1, Ibolya Csecs2, Ahmed Ibrahim Ahmed2
1Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
Insights
Patients with severe coronary artery calcium (CAC) on CT scans, even without known heart disease, face risks similar to those with established cardiovascular disease. This finding emphasizes the need for aggressive primary prevention strategies in this high-risk group.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Patients with coronary artery calcium (CAC) scores over 300 on computed tomography (CT) scans have a major adverse cardiac event (MACE) risk comparable to individuals with established atherosclerotic cardiovascular disease (ASCVD).
- The clinical significance of CAC detected during CT attenuation correction (CTAC) in nuclear myocardial perfusion imaging (MPI) for risk stratification is not fully understood.
Purpose of the Study:
- To determine the CAC extent on CTAC that signifies a risk level equivalent to secondary prevention criteria.
- To evaluate the association between CAC severity on CTAC and MACE in patients without a history of ASCVD.
Main Methods:
- Retrospective analysis of 17,901 patients undergoing nuclear MPI with CTAC.
- Visual estimation of CAC score (0-12) from CTAC, categorizing into zero, mild (1-2), moderate (3-6), and severe (≥7).
- Primary outcome: composite of death, myocardial infarction (MI), or late revascularization, compared between patients with and without prior ASCVD.
Main Results:
- Among 13,852 patients without prior ASCVD, 11% experienced MACE during follow-up.
- Patients without prior ASCVD but with severe CAC (score ≥7) showed no significant difference in MACE, MI, or all-cause mortality risk compared to patients with established ASCVD (P > 0.05).
- Severe CAC was identified in 11% of patients without prior ASCVD.
Conclusions:
- Severe CAC (score ≥7) on CTAC in patients without prior ASCVD indicates a cardiovascular risk comparable to those with known ASCVD.
- These findings suggest that patients with severe CAC on CTAC, even without a history of ASCVD, represent a high-risk primary prevention group requiring aggressive management.
- CTAC-derived CAC scoring can aid in identifying high-risk individuals who may benefit from intensified preventive therapies.
Background:
Patients with a coronary artery calcium (CAC) score >300 on dedicated CAC scoring computed tomography (CT) are at equivalent risk of major adverse cardiac events (MACE) as those with established atherosclerotic cardiovascular disease (ASCVD).
Objectives:
The aim of the study was to identify the extent of CAC on CT performed for attenuation correction (CTAC) as part of nuclear myocardial perfusion imaging that equates to secondary prevention.
Methods:
We retrospectively studied 17,901 patients (48% female, age 64 ± 12 years, body mass index 30 kg/m2 [26-36]) who underwent nuclear myocardial perfusion imaging with CTAC (single photon emission computed tomography/CT or positron emission tomography/CT) at a single center. Prior ASCVD was defined as myocardial infarction (MI), cerebrovascular accident, peripheral artery disease, or prior revascularization. A semiquantitative visually estimated CAC score was obtained by scoring CAC in each coronary artery from 0 (absent) to 3 (severe), yielding a total score of 0 to 12 (zero, mild 1-2, moderate 3-6, and severe ≥7). The primary outcome was the composite of death, MI, or late revascularization.
Results:
Among 13,852 patients without prior ASCVD (CAC zero 45%, mild 23%, moderate 21%, severe 11%) and 4,049 with ASCVD, 2,006 patients (11%) experienced MACE during a median follow-up of 25 (Q1-Q3: 10-43) months. In multivariable Cox regression, patients with severe calcification had no difference in risk for MACE, MI, or all-cause mortality vs ASCVD patients (P > 0.05).
Conclusions:
Patients without prior ASCVD but with severe CAC (score ≥7) on CTAC demonstrated a risk for cardiovascular events and mortality comparable to those with known ASCVD, highlighting the need for more aggressive management in this high-risk primary prevention group.
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