Background:
Cardiac CT angiography (CCTA) is a useful non-invasive tool to assess coronary artery disease (CAD). The CCTA derived modified Duke prognostic CAD index (MDS) has been shown to predict coronary events in symptomatic patients. No prior study has investigated MDS in asymptomatic patients or the relationship of conventional biomarkers of CAD with MDS.
Objective:
We sought to determine the ability of clinical, serologic, and imaging biomarkers of CAD to predict abnormal MDS in asymptomatic patients.
Methods:
There were 374 asymptomatic patients in the High Risk Plaque Study who were evaluated by clinical, serologic, and imaging biomarkers of CAD that underwent CCTA. MDS was calculated from CCTA using a 16-segment convention for coronary tree (high MDS defined as ≥3). The association of MDS with clinical, serologic, and imaging biomarkers was assessed.
Results:
There were 58 patients identified with high MDS. These patients had lower HDL-C (44 v. 53, p<0.001) and higher CACS (899 v. 26, p<0.001), Framingham risk score (17.5 v. 11, p<0.001), carotid intima-media thickness (0.82 v. 0.74, p=0.001), and triglycerides (150 v. 136, p = 0.011). In multivariate analysis, only CACS≥400 (OR = 15.3, 95% CI: 7.4-31.5, p<0.001) and CACS overall (OR = 6.02, 95% CI: 3.58 - 10.09, p<0.001) independently predicted MDS. Receiver operating characteristic curve analysis revealed improved prediction of MDS with addition of CACS: from AUC = 0.7531 to 0.8951.
Conclusion:
In asymptomatic patients, CACS is the strongest independent predictor of MDS when compared to conventional biomarkers of CAD.
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