Coronary Artery Calcium Score Predicts Major Adverse Cardiovascular Events in Stable Chest Pain,Radiology

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Coronary Artery Calcium Score Predicts Major Adverse Cardiovascular Events in Stable Chest Pain
Radiology ( IF 19.7 ) Pub Date : 2024-03-05 , DOI: 10.1148/radiol.231557
Federico Biavati , Luca Saba , Melinda Boussoussou , Klaus F. Kofoed , Theodora Benedek , Patrick Donnelly , José Rodríguez-Palomares , Andrejs Erglis , Cyril Štěchovský , Gintarė Šakalytė , Nada Čemerlić Ađić , Matthias Gutberlet , Jonathan D. Dodd , Ignacio Diez , Gershan Davis , Elke Zimmermann , Cezary Kępka , Radosav Vidakovic , Marco Francone , Małgorzata Ilnicka-Suckiel , Fabian Plank , Juhani Knuuti , Rita Faria , Stephen Schröder , Colin Berry , Balazs Ruzsics , Nina Rieckmann , Christine Kubiak , Kristian Schultz Hansen , Jacqueline Müller-Nordhorn , Pál Maurovich-Horvat , Per E. Sigvardsen , Imre Benedek , Clare Orr , Filipa Xavier Valente , Ligita Zvaigzne , Vojtěch Suchánek , Antanas Jankauskas , Filip Ađić , Michael Woinke , Diarmaid Cadogan , Iñigo Lecumberri , Erica Thwaite , Mariusz Kruk , Aleksandar N. Neskovic , Massimo Mancone , Donata Kuśmierz , Gudrun Feuchtner , Mikko Pietilä , Vasco Gama Ribeiro , Tanja Drosch , Christian Delles , Riccardo Cau , Michael Fisher , Bela Merkely , Charlotte Kragelund , Rosca Aurelian , Stephanie Kelly , Bruno García del Blanco , Ainhoa Rubio , Bálint Szilveszter , Jens D. Hove , Ioana Rodean , Susan Regan , Hug Cuéllar Calabria , István Ferenc Édes , Linnea Larsen , Roxana Hodas , Adriane E. Napp , Robert Haase , Sarah Feger , Mahmoud Mohamed , Lina M. Serna-Higuita , Konrad Neumann , Henryk Dreger , Matthias Rief , Viktoria Wieske , Matthew J. Budoff , Melanie Estrella , Peter Martus , Maria Bosserdt , Marc Dewey ,

Background

Coronary artery calcium (CAC) has prognostic value for major adverse cardiovascular events (MACE) in asymptomatic individuals, whereas its role in symptomatic patients is less clear.

Purpose

To assess the prognostic value of CAC scoring for MACE in participants with stable chest pain initially referred for invasive coronary angiography (ICA).

Materials and Methods

This prespecified subgroup analysis from the Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) trial, conducted between October 2015 and April 2019 across 26 centers in 16 countries, focused on adult patients with stable chest pain referred for ICA. Participants were randomly assigned to undergo either ICA or coronary CT. CAC scores from noncontrast CT scans were categorized into low, intermediate, and high groups based on scores of 0, 1–399, and 400 or higher, respectively. The end point of the study was the occurrence of MACE (myocardial infarction, stroke, and cardiovascular death) over a median 3.5-year follow-up, analyzed using Cox proportional hazard regression tests.

Results

The study involved 1749 participants (mean age, 60 years ± 10 [SD]; 992 female). The prevalence of obstructive coronary artery disease (CAD) at CT angiography rose from 4.1% (95% CI: 2.8, 5.8) in the CAC score 0 group to 76.1% (95% CI: 70.3, 81.2) in the CAC score 400 or higher group. Revascularization rates increased from 1.7% to 46.2% across the same groups (P < .001). The CAC score 0 group had a lower MACE risk (0.5%; HR, 0.08 [95% CI: 0.02, 0.30]; P < .001), as did the 1–399 CAC score group (1.9%; HR, 0.27 [95% CI: 0.13, 0.59]; P = .001), compared with the 400 or higher CAC score group (6.8%). No significant difference in MACE between sexes was observed (P = .68).

Conclusion

In participants with stable chest pain initially referred for ICA, a CAC score of 0 showed very low risk of MACE, and higher CAC scores showed increasing risk of obstructive CAD, revascularization, and MACE at follow-up.

Clinical trial registration no. NCT02400229

Supplemental material is available for this article.

See also the editorial by Hanneman and Gulsin in this issue.

中文翻译：

冠状动脉钙评分可预测稳定胸痛时的主要心血管不良事件

背景

冠状动脉钙（CAC）对无症状个体的主要不良心血管事件（MACE）具有预后价值，但其在有症状患者中的作用尚不清楚。

目的

评估 CAC 评分对于最初转诊进行侵入性冠状动脉造影 (ICA) 的稳定胸痛参与者的 MACE 的预后价值。

材料和方法

这项预先指定的亚组分析来自于 2015 年 10 月至 2019 年 4 月在 16 个国家的 26 个中心进行的稳定胸痛和中度冠状动脉疾病风险患者的诊断影像策略 (DISCHARGE) 试验，重点关注转诊的稳定胸痛成年患者对于ICA。参与者被随机分配接受 ICA 或冠状动脉 CT。非造影 CT 扫描的 CAC 评分分别根据 0、1-399 和 400 或更高分为低、中和高组。该研究的终点是中位 3.5 年随访期间 MACE（心肌梗塞、中风和心血管死亡）的发生情况，并使用 Cox 比例风险回归检验进行分析。

结果

该研究涉及 1749 名参与者（平均年龄，60 岁±10 [SD]；992 名女性）。 CT 血管造影中阻塞性冠状动脉疾病 (CAD) 的患病率从 CAC 评分 0 组的 4.1% (95% CI: 2.8, 5.8) 上升到 CAC 评分 400 或 400 组的 76.1% (95% CI: 70.3, 81.2)。较高组。同一组的血运重建率从 1.7% 增加到 46.2% ( P < .001)。 CAC 评分 0 组的 MACE 风险较低（0.5%；HR，0.08 [95% CI：0.02，0.30]；P < .001），CAC 评分 1-399 组的 MACE 风险较低（1.9%；HR，0.27 [95% CI：0.02，0.30]；P < .001）。 95% CI: 0.13, 0.59]；P = .001)，与 400 或更高 CAC 评分组 (6.8%) 相比。性别之间的 MACE 没有观察到显着差异 ( P = .68)。