scholarly journals Patients presenting with acute coronary syndromes have unreported coronary artery calcium on historical CT imaging

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Bradley ◽  
A Aggarwal ◽  
K Goatman ◽  
G Jones ◽  
C Berry ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Electronic Patient Record ◽  
Coronary Calcification ◽  
Ct Imaging ◽  
Radiology Reports ◽  
Clinical Radiology ◽  
The Mean

Abstract Introduction Ischaemic heart disease (IHD) remains the leading cause of mortality globally1. The presence and extent of coronary artery calcification (CAC) is a strong predictor of cardiovascular events, and CAC scoring has been shown to be more predictive of cardiovascular events than other traditional risk assessment scores2. Incidental coronary calcification can be detected and quantified on non-gated CT chest scans covering the heart in the field of view3. This finding is typically not reported4 and hence an opportunity to optimise cardiovascular risk assessment and treatment is missed. Purpose We sought to investigate whether patients presenting to our centre with an acute coronary syndrome (ACS) event had historical CT imaging demonstrating coronary artery calcification. Methods We retrospectively reviewed case records for all patients referred to our centre for an invasive coronary angiogram following their first known admission with an ACS event. ACS were defined according to contemporary guidelines from the European Society of Cardiology. We reviewed a 3 month period prior to the COVID-19 pandemic (01/01/2019–31/03/2019). The national imaging database was interrogated to identify previous CT imaging that includes the heart in the field of view. The presence of coronary calcification was confirmed and quantified using an ordinal scoring method previously described3. The clinical radiology reports for the scans were reviewed to determine the frequency of CAC being reported. Demographic information was collected from our electronic patient record including the presence of risk factors for IHD. Prescribed medication prior to admission was also recorded using the on-admission medicines reconciliation documented in the electronic patient record. Results 385 patients with first presentation of ACS were identified. 75 (19%) had a prior non-gated CT chest imaging. The most common indication for CT was for investigation of possible malignancy. The mean interval from CT imaging to ACS admission was 36 months. CAC was present on 67 (89%) scans. The mean ordinal score was 4.04, corresponding to moderate CAC. The distribution of CAC by coronary artery revealed the majority of disease to involve the left anterior descending artery (Table 1). Only 12/67 (18%) of clinical radiology reports mentioned coronary calcification (Figure 1). Patients with CAC frequently had additional risk factors for IHD. Despite this only 42% were prescribed antiplatelet therapy, and only 45% prescribed a statin. Conclusions A significant proportion of ACS admissions have evidence of CAC on historical CT scans. This finding is often not reported and the majority of patients with demonstrated coronary artery disease are not prescribed appropriate preventative therapies. Systematic reporting of this finding may have a significant impact on the prevention of acute cardiovascular events. FUNDunding Acknowledgement Type of funding sources: None. Table 1

scholarly journals Correlation between Osteoprotegerin Serum Level and Coronary Calcification Using Coronary Artery Calcium Score in Patient with Moderate–Severe Cardiovascular Risk Factor

2017 ◽  
Vol 26 (04) ◽  
pp. 234-237 ◽  
Author(s):  
Widorini Widorini ◽  
J. Nugroho
Keyword(s):  
Computed Tomography ◽  
Risk Factor ◽  
Coronary Artery ◽  
Serum Level ◽  
Coronary Artery Calcium ◽  
Coronary Artery Calcification ◽  
Calcium Score ◽  
Coronary Calcification ◽  
Cross Sectional ◽  
The Mean

AbstractCoronary artery calcification is a part of atherosclerosis process associated with coronary heart disease. Recently, coronary artery calcification assessment using computed tomography (CT) is still the best noninvasive imaging with high sensitivity and specificity. Osteoprotegerin (OPG) is one of vascular calcification marker that through its role to bind receptor activator of nuclear factor-κβ ligand and inhibit osteoclastogenesis is suspected of playing a role for coronary calcification in atherosclerosis process. The objective of this study was to prove a positive correlation between OPG serum level and coronary calcification using coronary artery calcium (CAC) score in patient with moderate–severe cardiovascular (CV) risk factor. This is a cross-sectional study with purposive sampling technique. Thirty-three subjects participate in this research and each subject underwent a multislice computed tomography (MSCT) examination to assess coronary calcification and their blood samples were collected for OPG measurement. This study is analyzed with Spearman's correlation test. The mean of OPG serum level in this study was 5.89 ± 2.1 pmol/L for moderate-risk Framingham risk score (FRS) and the mean of OPG serum level for high-risk FRS was 7.27 ± 3.4. There was a positive, moderate, and significant correlation between OPG serum level and coronary calcification using CAC score in patient with moderate–severe CV risk factor (r = 0.694; p < 0.001).

scholarly journals Coronary Calcification and Male Gender Predict Significant Stenosis in Symptomatic Patients in Northern and Southern Europe and the USA: A Euro-CCAD Study

2018 ◽  
Vol 13 ◽  
Author(s):  
Ying Zhao ◽  
Rachel Nicoll ◽  
Axel Diederichsen ◽  
Hans Mickley ◽  
Kristian Ovrehus ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Calcification ◽  
Ct Scanning ◽  
Fold Increase ◽  
Male Gender ◽  
Northern Europe ◽  
Southern Europe ◽  
Significant Stenosis ◽  
The Usa

Background and Aims: Significant stenosis is the principal cause of stable angina but its predictors and their variation by geographical region are unclear.Methods and Results: From the European Calcific Coronary Artery Disease (Euro-CCAD) cohort, we retrospectively investigated 5515 symptomatic patients from northern Europe (Denmark, France, Germany), southern Europe (Italy, Spain) and USA. All had conventional cardiovascular risk factor assessment, angiography and CT scanning for coronary artery calcium (CAC) scoring. There were differences in the patient characteristics between the groups, with the USA patients being younger and having more diet and lifestyle-related risk factors, although hypertension may have been better controlled than in Europe. USA patients had a two-fold increase in prevalence of significant stenosis and a three-fold increase in median CAC score. In all three groups, the log CAC score proved to be the strongest predictor of >50% stenosis followed by male gender. In the USA group, there were no additional independently predictive risk factors, although in northern Europe obesity, hypertension, smoking and hypercholesterolaemia remained predictive, with all risk factors other than hypertension proving to be predictive in the southern Europe group. Without the CAC score as a variable, male gender followed by diabetes were the most important predictors in all three regions, with hypertension also proving predictive in northern Europe.Conclusion:  In symptomatic patients, the CAC score and male gender were the two most important predictors of significant stenosis in symptomatic patients in northern and southern Europe and the USA.

scholarly journals Surviving a Decade or More After Coronary Revascularization in a Middle Eastern Population: The Impact of Diabetes Mellitus.

2021 ◽  
Author(s):  
Imad A Alhaddad ◽  
Ramzi Tabbalat ◽  
Yousef Khader ◽  
Zaid Elkarmi ◽  
Zaid Dahabreh ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Coronary Revascularization ◽  
Middle Eastern ◽  
Index Procedure ◽  
Repeat Revascularization ◽  
Study Population

Abstract Introduction and aimsThere is scarcity of studies that evaluate cardiovascular events and repeat revascularization among Middle Eastern patients who have long-term survival after coronary artery revascularization. In this study, patients who survived at least 10 years after percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) were assessed for the evolution of cardiovascular risk factors, occurrence of acute cardiovascular events and the need for further coronary revascularization procedures after the index coronary revascularization. Patients were classified according to the presence or absence of diabetes mellitus (DM) at baseline. MethodsThe study enrolled consecutive ambulatory or in-patients who had PCI or CABG at least 10 years prior to enrollment. Collected data included cardiovascular risk factors at the time of the index revascularization and evolution of risk factors since then, occurrence of cardiovascular events and the need for coronary revascularization after the index procedure. Events were compared between patients with DM and no DM at baseline. ResultsThe study population consisted of 891 consecutive patients with 351 patients (39.4%) had DM and 540 patients (60.6%) had no DM. Of all patients, 123 (13.8%) were females with the DM group had more females compared to no DM group (19.7 vs 10%, p <0.001). Mean age of the study population at baseline was 53.9 + 8.8 years for DM patients and 53.0 + 9.8 years for no DM patients (p=0.16). At baseline, the DM group had more hypertension (70.9% vs 27.6%, p<0.0001), more dyslipidemias (12% vs 5.2%, p=0.001) but less smokers compared to no DM group (44.4% vs 58.3%, p<0.001). DM and no DM groups had similar proportion of PCI (65.5% vs 68.3%, p=0.42) and CABG at baseline (34.5% vs 31.7%, p=0.43).The mean time elapsed since the index coronary revascularization was 13.5 + 3.5 years for DM patients and 14.4 + 4.8 years for no DM (p=0.02). Following the index revascularization procedure, ACS events occurred in 40.7% of diabetic patients and in 41.6% in no DM patients (p=0.82). Heart failure and stroke developed in similar proportions in the DM and no DM groups (12.5% vs 13.3%, p=0.51) and (4.6% vs 5.9%, p=0.75) respectively. Repeat revascularization after the index procedure showed that DM group had more PCI compared to no DM group (52.7% vs 45.4%, p= 0.04) but proportions of CABG (7.1% vs 9.8%, p=0.20). ConclusionsIn this retrospective observation of Middle Eastern patients who survived at least a decade after coronary revascularization, DM group had more hypertension and dyslipidemias but less smokers compared to no DM at baseline. During follow up, DM group required more PCI revascularization compared with no DM group.

Nghiên cứu ứng dụng kỹ thuật can thiệp trong điều trị bệnh nhân có tổn thương động mạch vành tại Bệnh viện Trung ương Huế

2021 ◽  
Author(s):  
Anh Binh Ho
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Risk Factors ◽  
Percutaneous Coronary Interventions ◽  
Central Hospital ◽  
Coronary Interventions ◽  
Percutaneous Coronary ◽  
The Mean ◽  
Artery Disease

TÓM TẮT Mục đích: Can thiệp động mạch vành là một phương pháp có hiệu quả cao trong điều trị bệnh động mạch vành trên thế giới. Tại Huế, kỹ thuật này đã được triển khai từ năm 1998 và được thực hiện một cách thường quy. Chúng tôi tiến hành đề tài này nhằm đánh giá lại hiệu quả của phương pháp can thiệp động mạch vành trên thực tế lâm sàng tại Bệnh viện Trung ương Huế. Phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang trên đối tượng bệnh nhân được chẩn đoán xác định bệnh động mạch vành và được can thiệp động mạch vành từ tháng 9 - 2010 tới tháng 6 - 2013. Kết quả: Bệnh động mạch vành: tăng huyết áp là yếu tố nguy cơ hàng đầu (56.36%), tiếp theo là rối loạn lipid máu (48.16%) và hút thuốc lá (33.9%). Các bệnh nhân có số yếu tố nguy cơ từ 2 - 4 chiếm đa số: 78.22%. Phần lớn bệnh nhân có tổn tương 1 - 2 mạch máu: chiếm 89.66 %. Tổn thương ĐM Liên thất trước nhiều nhất (67.63%), tiếp theo là ĐMV phải (45.18%) và ĐM Mũ (35.52%). Thấp nhất là tổn thương thân chung (0.86%). Chiều dài trung bình tổn thương ĐM liên thất trước và ĐM vành phải tương đương nhau: 16.98±9.4 mm & 16.05±8.7 mm (p> 0.05) và dài hơn so với ĐM Mũ 13.27±7.01 mm (p<0.05) và ĐM thân chung 9.73±2.77 mm (p< 0.05). Động mạch Liên thất trước được can thiệp nhiều nhất (51.75%), sau đó đến ĐM vành phải (32.53%) và động mạch Mũ (15.02%). Tổng số biến chứng của can thiệp động mạch vành là 2.9%, trong đó tử vong là 0.17%; NMCT là 0.34% và TBMMN là 0.085%. Kết luận: Can thiệp động mạch vành là một phương pháp điều trị có hiệu quả cao đối với bệnh nhân bệnh động mạch vành tại Bệnh viện Trung ương Huế, với tỷ lệ thành công rất cao và biến chứng thấp. Từ khoá: Động mạch vành, can thiệp, biến chứng ABSTRACT THE APPLICATION OF PERCUTANEOUS CORONARY INTERVENTIONS (PCIs) TO TREAT CORONARY ARTERY DISEASE IN HUE CENTRAL HOSPITAL Overview: Percutaneous Coronary Intervention (PCI) is a hightly effective method to treat coronary artery disease all over the world. At Hue, the proceduces have been undertaken since 1998 and now turn to be routine. This study is done to review the effectiveness of PCIs in Hue Central Hospital. Method: Cross-sectional description in patients with coronary artery diseases, who were undertaken percutaneous coronary interventions from September 2010 to June 2013. Results: Coronary risk factors include: Hypertension comes first (56.36%), then hyperlipidemia (48.16%) and smoking (33.9%). Most of patients have 2 to 4 risk factors (78.22%). Lesions on LAD are highest (67.63%), then on RCA (45.18%) and LCx (35.52%). Left main lesions are lowest (0.86%). The mean length leasions of LAD and RCA are equal: 16.98±9.4 mm & 16.05±8.7 mm (p> 0.05) and longer than the mean length leasions of LCx: 13.27±7.01 mm (p<0.05) and LM 9.73±2.77 mm (p< 0.05). PCIs have been undertaken on LAD lesions 51.75%, then RCA lesions 32.53% and LCx lesions15.02%. Total PCIs’complications are of 2.9%, including 0.17% of death, 0.34% of MI and 0.085% of CVA. Conclusion: Percutaneous Coronary Interventions (PCIs) have been undertaken effectively to treat coronary artery disease in Hue Central Hospital, with very high rate of success and very low rate of complication. Key words: Coronary artery disease, Percutaneous Coronary Interventions (PCIs), complication

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