The objective of this study was to examine the additive prognostic performance of
coronary artery calcium score (CACS) over coronary computed tomography angiography
(CCTA) stenosis assessment in symptomatic patients suspected for coronary artery disease
(CAD) undergoing CCTA. A total of 805 symptomatic patients without known history of
CAD who underwent coronary evaluation by multidetector cardiac CT were analyzed. Mean
age of the cohort was 58 ± 13 years. A total of 44% (354 of 805) of the patients had
a 0 CACS, 27% (215 of 805) had CACS 1 to 100, 14% (111 of 805) had CACS 101 to 400,
and 15% (125 of 805) had CACS >400. CCTA showed normal coronary arteries in 43% (349
of 805) of patients, ≤50% stenosis in 42% (333 of 805), and >50% stenosis in 15% (123
of 805). Patients were followed for 2.3 ± 0.9 years. Major adverse cardiac event (MACE)
was defined as cardiac death, nonfatal myocardial infarction, and late coronary revascularization.
Overall incidence of MACE was 1.4% per year. Both CACS and CCTA stenosis were independently
associated with increased MACE (p <0.05 for both). Addition of CACS into the model
with clinical risk factors and CCTA stenosis significantly improved predictive performance
for MACE from the model with clinical risk factors and CCTA stenosis only (global
chi-square score 108 vs 70; p = 0.019). In conclusion; in symptomatic patients without
known CAD, both CACS and CCTA stenosis were independently associated with increased
cardiac events, and performing non–contrast-enhanced CACS evaluation in addition to
contrast-enhanced CCTA improved predictive ability for future cardiac events compared
to CCTA stenosis assessment alone.
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References
- The coronary artery calcium score and stress myocardial perfusion imaging provide independent and complementary prediction of cardiac risk.J Am Coll Cardiol. 2009; 54: 1872-1882
- Stable coronary artery disease: prognostic value of myocardial perfusion SPECT in relation to coronary calcium scoring—long-term follow-up.Radiology. 2009; 252: 682-690
- Prevalence and severity of coronary artery disease and adverse events among symptomatic patients with coronary artery calcification scores of zero undergoing coronary computed tomography angiography: results from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: an International Multicenter) registry.J Am Coll Cardiol. 2011; 58: 2533-2540
- Does coronary CT angiography improve risk stratification over coronary calcium scoring in symptomatic patients with suspected coronary artery disease? Results from the prospective multicenter international CONFIRM registry.Eur Heart J Cardiovasc Imaging. 2014; 15: 267-274
- Prognostic value of coronary computed tomographic angiography in comparison with calcium scoring and clinical risk scores.Circ Cardiovasc Imaging. 2011; 4: 16-23
- Coronary calcium as a predictor of coronary events in four racial or ethnic groups.N Engl J Med. 2008; 358: 1336-1345
- Coronary artery calcium score and risk classification for coronary heart disease prediction.JAMA. 2010; 303: 1610-1616
- Prognostic significance of calcified plaque among symptomatic patients with nonobstructive coronary artery disease.J Nucl Cardiol. 2014; 21: 453-466
- Coronary artery calcium scoring does not add prognostic value to standard 64-section CT angiography protocol in low-risk patients suspected of having coronary artery disease.Radiology. 2011; 259: 92-99
- Incremental prognostic value of coronary artery calcium score versus CT angiography among symptomatic patients without known coronary artery disease.Atherosclerosis. 2014; 233: 190-195
- Does coronary artery calcium scoring add to the predictive value of coronary computed tomography angiography for adverse cardiovascular events in low-risk chest pain patients?.Acad Emerg Med. 2011; 18: 1065-1071
- Incremental prognostic value of different components of coronary atherosclerotic plaque at cardiac CT angiography beyond coronary calcification in patients with acute chest pain.Radiology. 2012; 264: 679-690
- Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study.Circulation. 1995; 92: 2157-2162
- Diagnostic and prognostic value of absence of coronary artery calcification.JACC Cardiovasc Imaging. 2009; 2: 675-688
- Meaning of zero coronary calcium score in symptomatic patients referred for coronary computed tomographic angiography.Eur Heart J Cardiovasc Imaging. 2012; 13: 776-785
- Influence of coronary calcification on the diagnostic accuracy of 64-slice computed tomography coronary angiography: a systematic review and meta-analysis.Int J Cardiovasc Imaging. 2012; 28: 943-953
- Diagnostic accuracy of computed tomography coronary angiography according to pre-test probability of coronary artery disease and severity of coronary arterial calcification. The CORE-64 (Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography) International Multicenter Study.J Am Coll Cardiol. 2012; 59: 379-387
- Predictors of inaccurate coronary arterial stenosis assessment by CT angiography.JACC Cardiovasc Imaging. 2013; 6: 963-972
Article Info
Publication History
Published online: January 05, 2015
Accepted:
December 23,
2014
Received in revised form:
December 23,
2014
Received:
November 13,
2014
Footnotes
See page 743 for disclosure information.
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Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.