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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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.
