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<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
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