Relation of coronary calcium scores by electron beam tomography to obstructive disease in 2,115 symptomatic patients

doi:10.1016/j.amjcard.2004.01.044

The American Journal of Cardiology

Volume 93, Issue 9, 1 May 2004, Pages 1150-1152

https://doi.org/10.1016/j.amjcard.2004.01.044 Get rights and content

Abstract

This angiographically correlated study reports on, for the first time, age- and gender-based distribution of the volumetric calcium score in a large group of patients with suspected coronary artery disease. Volumetric calcium data predicted significant coronary artery disease (≥50% lumen diameter stenosis) as well as the traditional Agatston score. Exclusion of any calcium was highly accurate in ruling out obstructive disease in symptomatic subjects ≥50 years of age.

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Cited by (117)

The power of zero calcium in 82-Rubidium PET irrespective of sex and age
2023, Journal of Nuclear Cardiology
Despite clinical suspicion, many non-invasive tests for coronary artery disease (CAD) are normal. Coronary artery calcification score (CACS) is a well-validated method to detect and risk stratify CAD. Patients with zero calcium score (ZCS) rarely have abnormal tests. Therefore, aims were to evaluate CACS as a gatekeeper to further functional downstream testing for CAD and estimate potential radiation and cost savings.
Consecutive patients with suspected CAD referred for PET were included (n = 2640). Prevalence and test characteristics of ZCS were calculated in different groups. Summed stress score ≥ 4 was considered abnormal and summed difference score ≥ 7 equivalent to ≥ 10% ischemia. To estimate potential radiation/cost reduction, PET scans were hypothetically omitted in ZCS patients.
Mean age was 65 ± 11 years, 46% were female. 21% scans were abnormal and 26% of patients had ZCS. CACS was higher in abnormal PET (median 561 vs 27, P < 0.001). Abnormal PET was significantly less frequent in ZCS patients (2.6% vs 27.6%, P < 0.001). Sensitivity/negative predictive value (NPV) of ZCS to detect/exclude abnormal PET and ≥ 10% ischemia were 96.8% (95%-CI 95.0%-97.9%)/97.4% (95.9%-98.3%) and 98.9% (96.7%-99.6%)/99.6% (98.7%-99.9%), respectively. Radiation and cost reduction were estimated to be 23% and 22%, respectively.
ZCS is frequent, and most often consistent with normal PET scans. ZCS offers an excellent NPV to exclude an abnormal PET and ≥ 10% ischemia across different gender and age groups. CACS is a suitable gatekeeper before advanced cardiac imaging, and potential radiation/cost savings are substantial. However, further studies including safety endpoints are needed.
Cardiac Society of Australia and New Zealand Position Statement: Coronary Artery Calcium Scoring
2017, Heart Lung and Circulation
Coronary Artery Calcium Scoring (CAC) is a non-invasive quantitation of coronary artery calcification using computed tomography (CT). It is a marker of atherosclerotic plaque burden and an independent predictor of future myocardial infarction and mortality.
Coronary Artery Calcium Scoring provides incremental risk information beyond traditional risk calculators (eg. Framingham Risk Score). Its use for risk stratification is confined to primary prevention of cardiovascular events, and can be considered as “individualised coronary risk scoring” for those not considered to be of high or low risk. Medical practitioners should carefully counsel patients prior to CAC. Coronary Artery Calcium Scoring should only be undertaken if an alteration in therapy including embarking on pharmacotherapy is being considered based on the test result.
Patient Groups to Consider Coronary Calcium Scoring:
- 1.
  CAC is of most value in intermediate risk patients (absolute 10-year cardiovascular risk of 10–20%) who are asymptomatic, do not have known coronary artery disease and aged 45–75 years, where it has the ability to reclassify patients into lower or higher risk groups.
- 2.
  It may also be considered for lower risk patients (absolute 10-year cardiovascular risk 6–10%) particularly in those where traditionally risk scores under estimate risk e.g. especially in the context of family history of premature cardiovascular disease (CVD) and possibly in patients with diabetes aged 40 to 60 years old.
Patient Groups in Whom Coronary Calcium Scoring Should Not be Considered:
Coronary Artery Calcium Scoring is not recommended for patients who are:
- 1.
  At very low risk (<5% absolute 10 year risk); or,
- 2.
  High risk ( >20% absolute 10 year risk) – as testing is unlikely to alter the recommended management. This includes some patients who are automatically considered to be high risk (eg. diabetics over 60 years old or diabetics with albuminuria, chronic kidney disease (eGFR <45 mL/min), BP >180/110, familial hypercholesterolaemia and cholesterol >7.5 mmol/L) and therefore should be managed aggressively with optimal medical therapy; or
- 3.
  Symptomatic or previously documented coronary artery disease.
Interpretation of CAC
CAC = 0 A zero score confers a very low risk of death, <1% at 10 years.
CAC = 1-100 Low risk, <10%
CAC = 101-400 Intermediate risk, 10–20%
CAC = 101-400 & >75th centile. Moderately high risk, 15–20%
CAC >400 High risk, >20%
Management Recommendations Based on CAC
Optimal diet and lifestyle measures are encouraged in all risk groups and form the basis of primary prevention strategies. Patients with moderately-high or high risk based on CAC score are recommended to receive preventative medical therapy such as aspirin and statins. The evidence for pharmacotherapy is less robust in patients at intermediate levels of CAC 100–400, with modest benefit for aspirin use; though statins may be reasonable if they are above 75th centile. Aspirin and statins are generally not recommended in patients with CAC <100.
Repeat CAC Testing
In patients with a CAC of 0, a repeat CAC may be considered in 5 years but not sooner.
In patients with positive calcium score, routine re-scanning is not currently recommended. However, an annual increase in CAC of >15% or annual increase of CAC >100 units are predictive of future myocardial infarction and mortality.
Cost Effectiveness of CAC Based Primary Prevention Recommendations:
There is currently no data in Australia and New Zealand that CAC is cost-effective in informing primary prevention decisions. Given the cost of testing is currently borne entirely by the patient, discussion regarding the implications of CAC results should occur before CAC is recommended and undertaken.
Coronary Calcium Scoring as the Gate Keeper for Stress Myocardial Perfusion Imaging: Antagonist
2017, Journal of Nuclear Cardiology
Coronary computed tomography angiography and calcium scoring in routine clinical practice for identification of patients who require revascularization
2016, Archives of Cardiovascular Diseases
The predictive value of CCTA to predict coronary artery disease is high in particular in the absence of coronary calcification. However, the consideration of both CCTA and the calcium score, in addition to the risk factors to determine the indication for coronary revascularization, has not been yet studied.
This study included 2302 patients (mean age: 60 ± 9.8 years, 46% men), without known coronary artery disease (CAD), who underwent 320-row CCTA. Logistic regression, c-statistic and net reclassification improvement (NRI) were used to assess the role of coronary artery calcium score (CACS) in predicting revascularization after CCTA.
The revascularization rates were 0.75% in patients with a CACS of 0, and there were no adverse events during the follow-up period. The revascularization rates were 3.3% in patients with a CACS of 1–99, 15.4% in patients with a CACS of 100–399, 25.6% in patients with a CACS of 400–999, and 42.4% in patients with a CACS ≥ 1000. The crude and adjusted odds ratios (95% confidence interval) for revascularization per CACS group category were 2.89 (2.53–2.3) and 2.71 (2.33–3.15), respectively; the area under the ROC curve (AUC) was 0.85 (0.83–0.88). The addition of CACS to conventional risk factors improved the accuracy of risk prediction model for revascularization (AUC 0.74 vs 0.63, P = 0.001), but it did not reclassify a substantial proportion of patients with positive CACS to risk categories (NRI = −0.023, P = 0.66).
The 320-row CCTA might rule out CAD in low- to intermediate-risk patients. However, its accuracy in identifying patients who require revascularization is limited. The CACS added to the conventional risk factors did not improve the identification of patients who require revascularization.
La valeur prédictive du coronaroscanner pour éliminer une coronaropathie est élevée en particulier en l’absence de calcification coronaire. Cependant, la prise en compte simultanée des résultats du coronaroscanner, et de l’évaluation du score calcique en sus de la prise en compte des facteurs de risque pour déterminer l’indication à une revascularisation, n’a pas été étudiée à ce jour.
Cette étude a inclus 2302 patients, d’âge moyen 60 ± 9,8 ans, 46 % de sexe masculin, sans coronaropathie connue qui ont bénéficié d’une coronaroscanner. La régression logistique, le score C-statistic et l’amélioration nette de la reclassification (NRI) ont été utilisés pour évaluer le rôle du score calcique dans la prédiction de l’indication à une revascularisation au décours d’un coronaroscanner.
Le taux de revascularisation était de 0,75 % chez les patients ayant un score calcique = 0 et il n’y avait pas d’évènement indésirable colligé pendant la période de suivi. Le taux de revascularisation était de 3,3 % chez les patients ayant un score calcique entre 0 et 99, 15,4 % lorsque ce score était entre 100 et 399, 25,6 % lorsque ce score était entre 400 et 999 et 42,4 % chez les patients ayant un score ≥ 1000. Les odds ratios brut et ajusté avec IC 95 % pour l’indication à la revascularisation par catégorie de score calcique étaient de 2,89 (IC 95 % −2,3–2,53) et de 2,71 (IC 95 % 2,33–3,15), respectivement. La surface sous la courbe ROC était à 0,85 (IC 95 % 0,83–0,88). Le fait de prendre en considération les facteurs de risque en sus du score calcique améliore la précision du modèle pour prédire l’indication à une revascularisation puisque la surface sur la courbe ROC passe de 0,63 à 0,74, p = 0,001. En revanche, il n’y a pas d’amélioration de la classification correcte des patients en utilisant le résultat du score calcique par catégorie, puisque le NRI est égal à −0,023, p = 0,66.
Le coronaroscanner peut éliminer une coronaropathie chez les patients à faible risque où à risque intermédiaire. Cependant, sa capacité à identifier les patients ayant une indication à une revascularisation est limitée. Le score calcique améliore la prédiction d’un geste de revascularisation, en sus de la prise en compte des facteurs de risque cardiovasculaire mais n’améliore pas l’identification des patients ayant une indication à revascularisation.
Positron-Emission Tomography Imaging
2014, Pathobiology of Human Disease: A Dynamic Encyclopedia of Disease Mechanisms
During the last two decades, we have witnessed a significant improvement in the prevention and management of coronary artery disease (CAD) and its devastating consequences. Despite these efforts, however, cardiovascular disease (especially CAD and its sequelae) remains highly prevalent and it represents a health-care burden in industrialized and developing countries. This has resulted in a continued expansion and refinement of our noninvasive imaging approaches to improve diagnosis and risk prediction. Positron-emission tomography is a powerful noninvasive imaging tool for phenotyping patients at risk or with known CAD that has been evolving over the past 30 years.
Imaging atherosclerosis for cardiovascular risk prediction- in search of the holy grail!
2018, Indian Heart Journal

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Relation of coronary calcium scores by electron beam tomography to obstructive disease in 2,115 symptomatic patients

Abstract

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

American College of Cardiology/American Heart Association Expert Consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease

Circulation

Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study

Circulation