scholarly journals Prognostic value of the coronary artery calcium score in suspected coronary artery disease: a study of 644 symptomatic patients

2019 ◽  
Vol 28 (1) ◽  
pp. 44-50 ◽  
Author(s):  
D. Rijlaarsdam-Hermsen ◽  
M. S. Lo-Kioeng-Shioe ◽  
D. Kuijpers ◽  
R. T. van Domburg ◽  
J. W. Deckers ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Calcium Score ◽  
Coronary Revascularisation ◽  
Cardiac Events ◽  
Prognostic Information ◽  
Increased Risk ◽  
Fatal Myocardial Infarction

Abstract Aim The long-term value of coronary artery calcium (CAC) scanning has not been studied extensively in symptomatic patients, but was evaluated by us in 644 consecutive patients referred for stable chest pain. Methods We excluded patients with a history of cardiovascular disease and with a CAC score of zero. CAC scanning was done with a 16-row MDCT scanner. Endpoints were: (a) overall mortality, (b) mortality or non-fatal myocardial infarction and (c) the composite of mortality, myocardial infarction or coronary revascularisation. Revascularisations within 1 year following CAC scanning were not considered. Results The mean age of the 320 women and 324 men was 63 years. Follow-up was over 8 years. There were 58 mortalities, while 22 patients suffered non-fatal myocardial infarction and 24 underwent coronary revascularisation, providing 104 combined endpoints. Cumulative 8‑year survival was 95% with CAC score <100, 90% in patients with CAC score >100 and <400, and 82% with CAC score ≥400 Agatston units. Risk of mortality with a CAC score >100 and ≥400 units was 2.6 [95% confidence interval (CI) 1.23–5.54], and 4.6 (95% CI 2.1–9.47) respectively. After correction for clinical risk factors, CAC score remained independently associated with increased risk of cardiac events. Conclusions Risk increased with increasing CAC score. Patients with CAC >100 or ≥400 Agatston units were at increased risk of major adverse cardiac events and are eligible for preventive measures. CAC scanning provided incremental prognostic information to guide the choice of diagnostic and therapeutic options in many subjects evaluated for chest pain.

The prognostic impact of coronary calcium score in low risk patients presenting with chest pain; a 6-year follow-up single center study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Thalamus ◽  
C.C Gibbs ◽  
M.E Topper ◽  
C Oestvold ◽  
K Heldal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Event Rate ◽  
Calcium Score ◽  
Coronary Calcium ◽  
Coronary Calcium Score

Abstract Background Evaluation and risk stratification of patients with chest pain is a frequent task in cardiology. Coronary artery calcium is an established risk marker and is in wide clinical use. However, less is known about the long-term prognostic implications of coronary calcium score values in low risk individuals. Purpose We wanted to investigate the long-term outcome related to coronary artery calcium score (CAC). Methods We included patients who were examined with coronary CT angiography or GT SPECT from August 2011 to August 2015. The coronary calcium score percentile was calculated using the MESA Coronary Artery Calcium (CAC) Score Reference Values web tool. We excluded patients already stratified as high risk due to previous myocardial infarction or coronary revascularization. The primary endpoint was a composite of 5 point MACE (death, myocardial infarction, PCI, CABG and stroke) and was extracted from the electronic medical records. We censored follow up on the 31st December 2018. Results We included 1975 patients (958 (48.5%) male, age 60.3±12.0). The average CAC was 288±701. After median follow up of 6.0 (5.3–6.5 IQR) years, 372 patients fulfilled a primary endpoint. Event rate increased significantly with higher percentiles of CAC score (log rank 0.001, Figure 1). A total of 687 patients had a CAC score of 0. In this group we observed only 21 events during 6 years follow up, giving an annual event rate of 0.6%. Annual event rate in the patients with CAC percentile 1–75 was 3.2% and in the patients with CAC percentile 75–99 annual event rate was 5.6%. Death occurred in 10% of patients in the two upper percentiles compared to only 2% in the lowest percentile (p&lt;0.001) Conclusion Our findings support that CAC is a powerful predictor of coronary artery events. Furthermore, our study confirms excellent long term prognosis regarding cardiac events in patients with 0 CAC, which is helpful in risk stratification of patients with chest pain. Figure 1 Funding Acknowledgement Type of funding source: None

P4496Copeptin and coronary artery calcium score in elderly adults without a cardiovascular history. A report from the ICELAND MI cohort

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M I Smaradottir ◽  
K Andersen ◽  
G Eiriksdottir ◽  
V Gudnason ◽  
P Nasman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Cardiovascular Events ◽  
Age Groups ◽  
Rank Correlation ◽  
Total Mortality ◽  
Calcium Score ◽  
Secondary Outcome ◽  
Copeptin Level

Abstract Background Copeptin, a marker for vasopressin, is related to advanced cardiovascular disease such as myocardial infarction. Purpose The aim of the present investigation was to assess whether copeptin is associated with the different atherosclerotic plaque stages expressed by coronary artery calcium scores (CAC score). Methods Copeptin and CAC score were studied in 677 participants in the ICELANDIC MI cohort without a history of a myocardial infarction at baseline. The Agatston method was used to measure coronary artery calcification visualized by means of computed tomographic scans. The CAC score was categorized into four classes: 0, 1–99, 100–399, and ≥400. Correlations between the CAC score and copeptin were assessed using Spearman's Rank Correlation while the predictive value of copeptin and CAC score were evaluated with Cox proportional Hazard regression analysis (unadjusted and adjusted for age groups, serum creatinine, gender, hypertension and type 2 diabetes mellitus). The primary outcome was cardiovascular events (CVE) while total mortality served as secondary outcome. Results The median copeptin level was 6.4 pmol/L and the median CAC score 227.0 (IQR: 48.3–692.4) for the total cohort. The highest copeptin level was seen in people with a CAC score ≥400. Copeptin predicted total mortality in the unadjusted analysis and the CAC score predicted both outcomes. Only the CAC score that predicted outcome following adjustments (CVE: HR 1.35, 95% CI 1.23–1.48; p<0.001; and total mortality: HR 1.29, 95% CI 1.16–1.43; p<0.001). The cardiovascular prognosis was similar in those with CAC score less than 400 and above 400 regardless of the copeptin level (Figure). Figure 1 Conclusion In this cohort of elderly individuals without a previous MI a high CAC score was as a significant predictor of future cardiovascular events. People with high a CAC score had elevated copeptin levels but copeptin did not serve as a prognostic indicator. This suggests that copeptin elevation in people with CAD is an expression for the general state of disease rather than an indicator of a pathophysiological role of vasopressin in this context.

Abstract 456: Is There a Relationship Between an Elevated Coronary Calcium Score and the Incidence of Kidney or Gallbladder Calculi

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Vishesh Kumar ◽  
Shawn Kelly ◽  
Amol Raizada ◽  
Amornpol Anuwatworn ◽  
Jimmy Yee ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Coronary Artery Calcium Score ◽  
Medical Center ◽  
Calcium Score ◽  
Coronary Calcium ◽  
Calcium Deposition ◽  
Biochemical Basis ◽  
Asymptomatic Patients ◽  
Increased Risk

Background: Elevated calcium score is a marker of increased risk in the development of cardiovascular and cerebrovascular disease. It is unknown whether an elevated coronary artery calcium score is associated with extravascular calcium deposition in disease states such as nephrolithiasis and cholelithiasis. The aim of this study was to explore this relationship in asymptomatic patients who had elective coronary calcium scoring performed at the University of South Dakota Sanford Medical Center. Methods: We performed a retrospective review of data from 38,546 consecutive patients from the coronary calcium screening database. Patients with a history of calculi were identified using ICD-9 codes for calculus of kidney and ureter (592) and cholelithiasis (574). Cases were analyzed according to gender and age groups, and proportions calculated according to calcium score tertile. Results: The results are summarized in Table 1. Overall, the proportion of patients with calculi increases with each rise in the coronary artery calcium score. However, this relationship is best demonstrated in the elderly male and younger female populations. This relationship was further analyzed using a chi-square contrast test. The results, as described in Table 2, indicate that there is a significant relationship between elevated coronary calcium and likelihood of calculi conditions in young females (p=0.0040), however, the proportion in elderly males does not exhibit a statistical difference in proportion (p=0.1143). Conclusion: Elevated coronary artery calcium is associated with an increased likelihood of having a diagnosis of extravascular calculi development such as nephrolithiasis or cholelithiasis. Younger females appear to best demonstrate this relationship. Although the proportions are small, further studies are needed to substantiate a biochemical basis for this relationship.

Abstract P334: Distribution of Coronary Artery Calcium Score in a Multi-Ethnic Admixed Population: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Marcio S Bittencourt ◽  
Alexandre C Pereira ◽  
Henrique L Staniak ◽  
Itamar S Santos ◽  
Rodolfo Sharovsky ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Strong Predictor ◽  
Calcium Score ◽  
Adult Health ◽  
Local Regression ◽  
Final Population ◽  
Increased Risk ◽  
Admixed Population

Introduction: Coronary artery calcium (CAC) is a marker of coronary atherosclerosis burden and is a strong predictor of cardiovascular events and overall mortality, especially in White populations. The distribution of CAC has been determined for a number of predominantly White populations; however, the distribution in ethnically admixed groups has not been well established. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort with 15, 105 participants with an ethnic diversity (White, 52.2%; Brown, 28.2%; Black,16.1%; Asian, 2.5% and Native, 1.0%) is an unique opportunity to explore CAC scores differences among admixed populations. Hypothesis: to compare CAC scores obtained from an admixed population in Brazil with the results from the Multi Ethnic Study of Atherosclerosis (MESA). Methods: From the 15105 participants of ELSA-Brasil, a prospective study that enrolled civil servants aged 35 to 74 years, CAC scoring was performed on 3,400 individuals at the Sao Paulo site. Similar to previous studies, individuals with self-reported cardiovascular diseases or treated diabetes were excluded from the analysis. The final population included 2,753 individuals (men = 54%; median age = 48 years). Percentiles of CAC distribution were estimated using a two-part local regression fitting model, adapted to zero-inflated data and then compared to MESA CAC percentiles. Testing of the predictive role of age (years), sex, and ethnicity was done modeling a zero-inflated distribution for continuous data. Results: For the discrete part of CAC modelling, age, sex and ethnicity were predictors of CAC prevalence (CAC>0). For the ELSA-Brasil sample, increasing age (OR=1.14, p<0.001), male sex (OR: 3.61, p<0.001), and White ethnicity (OR=1.46 (against Blacks), p=0.02) were significantly associated with increased odds of having CAC>0. Different from expected, for the continuous part of CAC modelling, only age (p=0.02) was significantly associated with increased CAC values. Compared to MESA percentiles, the participants or ELSA-Brasil presented, overall, lower CAC values. Conclusions: Among this sample of apparently healthy Brazilian adults, we did observe significant differences in CAC prevalence by ethnicity, sex, and age. In contrast with MESA, the difference regarding the amount of CAC between men and women were smaller, suggesting an increased risk of Brazilian women compared to US women.

Abstract 224: Obesity Paradox in Coronary Artery Disease in Patients With Acute Chest Pain

Hypertension ◽  
2013 ◽  
Vol 62 (suppl_1) ◽  
Author(s):  
Kongkiat Chaikriangkrai ◽  
Mahwash Kassi ◽  
Sayf Khaleel bala ◽  
Su Min Chang
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Coronary Artery Calcium Score ◽  
Calcium Score ◽  
Acute Chest Pain ◽  
P Value ◽  
Artery Disease ◽  
Severe Calcification

Introduction Obesity has been inconsistently linked with coronary artery calcium score (CACS) as a surrogate of coronary artery disease (CAD) in asymptomatic subjects. Our aim was to examine whether there is relationship between obesity defined by BMI≥30kg/m 2 and presence and severity of CAD defined by CACS in patients with acute chest pain. Methods In this cross-sectional study, 1030 consecutive patients without reported history of coronary artery disease who presented with acute chest pain were included. CACS by non-contrast CT scan and BMI were collected. Patients were categorized by CACS classifications and BMI. Results The population with mean age of 54±13 years, 33% (338 of 1030) of patients being overweight and 46% (477 of 1030) being obese consisted of 60.6% (624 of 1030) patients with zero CACS, 21.7% (223 of 1030) with mild calcification (0<CACS<100) and 17.8% (183 of 1030) with moderate-to-severe calcification (CACS≥100). Compared to non-overweight/non-obese group, obese group had less patients with moderate-to-severe calcification (69 of 477; 14.5% VS 50 of 215; 22.6% p-value=0.016) despite more patients with hypertension (311 of 477; 65.2% VS 98 of 215; 45.6% p-value<0.001), diabetes (98 of 477; 20.5% VS 11 of 215; 5.1% p-value<0.001) and hyperlipidemia(174 of 477; 36.5% VS 57 of 215; 26.5% p-value=0.010). Obesity is INVERSELY associated with presence of CACS and moderate-to-severe calcification in multivariable logistic regression analysis (table 1). Conclusion Obesity defined by body mass index ≥ 30kg/m 2 is INVERSELY associated with presence and severity of coronary artery disease defined by coronary artery calcium score in patients with acute chest pain.

scholarly journals Correction to: Postmortem coronary artery calcium score in cases of myocardial infarction

2021 ◽  
Author(s):  
Katarzyna Michaud ◽  
Virginie Magnin ◽  
Mohamed Faouzi ◽  
Tony Fracasso ◽  
Diego Aguiar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Coronary Artery Calcium Score ◽  
Calcium Score

Abstract 16606: 30-day and 2-year Prognostic Information of Total Atheroma Volume, Segment Stenosis Score, and Traditional Coronary Artery Stenosis Assessment by CT Angiography - Results From the CORE320 International Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Armin Arbab-Zadeh ◽  
Tiago Magalhaes ◽  
Satoru Kishi ◽  
Carlos Rochitte ◽  
Marcus Y Chen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chest Pain ◽  
Coronary Artery ◽  
Ct Angiography ◽  
Cardiac Death ◽  
Area Under The Curve ◽  
Acute Chest Pain ◽  
Cardiac Events ◽  
Prognostic Information ◽  
Atheroma Volume

Introduction: Among abundant information on coronary artery disease (CAD) features by CT angiography (CTA), total atheroma volume and segment stenosis score (SSS) have recently shown promise for clinical utility. Methods: We followed 379 patients with suspected or known CAD enrolled in the CORE320 study for 2 years after 320-detector row CT coronary angiography. CT images were analyzed for semi-automatically derived total % atheroma volume (total atherosclerotic burden/vessel volume analyzed) and SSS in addition to traditional stenosis assessment (≥50%). Outcome variables were 1) 30-day revascularization and 2) major adverse cardiac events (MACE) after 2 years follow up. Events included cardiac death, myocardial infarction, hospitalization for acute chest pain or heart failure, arrhythmia, and revascularization. Area under the curve (AUC) and Kaplan-Meyer analysis were used to compare risk prediction and survival analysis according to CT CAD characteristics. Results: Thirty-day revascularization was most accurately predicted by CT stenosis assessment (AUC 75, confidence interval [CI] 71-80) vs. % atheroma volume (70 [65-74] and CTA SSS (67 [62-72]) (p=0.007). Prediction of MACE (45 late revascularizations, 5 myocardial infarctions, 1 cardiac death, 8 hospitalizations for chest pain or congestive heart failure, and 1 arrhythmia) was similar for % atheroma volume (64 [71 for patients without history of CAD]) and CTA stenosis assessment (65 [70]) but risk discrimination using common criteria trended favorably for % atheroma volume (FIGURE). Accuracy was low for CTA SSS (58 [62]). Conclusions: Semi-automated assessment of % total atheroma volume by CTA performs similarly to standard stenosis assessment for predicting short and long term event rates, especially revascularization, in patients with suspected CAD and holds promise for more nuanced risk discrimination. In contrast, CTA segment stenosis score performed only modestly in our analysis.

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