Coronary Artery Calcium Score Predicts Major Adverse Cardiovascular Events in Stable Chest Pain
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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.
| Originalsprog | Engelsk |
|---|---|
| Artikelnummer | e231557 |
| Tidsskrift | Radiology |
| Vol/bind | 310 |
| Udgave nummer | 3 |
| Antal sider | 11 |
| ISSN | 0033-8419 |
| DOI | |
| Status | Udgivet - 2024 |
Bibliografisk note
Funding Information:
Supported by grants from the EU-FP7 Framework Programme (FP 2007-2013, EC-GA 603266) to M.D. and other grants (Berlin Institute of Health [grant from Digital Health Accelerator]; the British Heart Foundation [Centre of Research Excellence grant no. RE/18/6/34217]; Rigshospitalet, University of Copenhagen [grant and nonfinancial support]; the Deutsche Forschungsgemeinschaft [German Research Foundation] [grants from Radiomics Priority Programme: DE 1361/19-1 {428222922} and 20-1 {428223139} in SPP2177/1], and grants from the BIOQIC graduate program [GRK 2260/1 {289347353}]). The DISCHARGE trial is associated with and endorsed by DZHK (German Centre for Cardiovascular Research) and we greatly acknowledge this collaborative network.
Funding Information:
Disclosures of conflicts of interest: F.B. No relevant relationships. L.S. No relevant relationships. M. Boussoussou No relevant relationships. K.F.K. Grants from A.P. Møller og Hustru Chastine Mc-Kinney Møllers Fond, Novo Nordisk Foundation, Sygeforsikringen Danmark, Research Council of Rigshospitalet, The University of Copenhagen, The Danish Heart Foundation, The Danish Agency for Science, Technology and Innovation by The Danish Council for Strategic Research, Canon Medical Systems, and GE HealthCare; payment for lectures from Canon Healthcare; support to attend meetings or travel from Canon Healthcare and GE HealthCare. T.B. No relevant relationships. P.D. Member of the Society of Cardiovascular Computed Tomography Membership Committee. J.R.P. No relevant relationships. A.E. No relevant relationships. C.Š. No relevant relationships. G.Š. No relevant relationships. N.Č.A. No relevant relationships. M.G. Honorarium from Bayer. J.D.D. Royalties from Elsevier; associate editor of Radiology and Quarterly Journal of Medicine; editorial board member for Radiology: Cardiothoracic Imaging. I.D. No relevant relationships. G.D. No relevant relationships. E.Z. No relevant relationships. C. Kępka No relevant relationships. R.V. No relevant relationships. M. Francone No relevant relationships. M.I.S. No relevant relationships. F.P. No relevant relationships. J.K. Consulting fees for study review protocols from GE HealthCare and Synektik Pharma; speaker fees from Lundbeck, Bayer, Boehringer Ingelheim, Pfizer, and Siemens Healthineers. R.F. No relevant relationships. S.S. No relevant relationships. C.B. Research funding from the British Heart Foundation, Chief Scientist Office of the Engineering and Physical Sciences Research Council, European Union, and Medical Research Council; consultancy and research agreements through institution with Abbott Vascular, AstraZeneca, Boehringer Ingelheim, Coroventis, HeartFlow, Menarini, MSD, Novartis, Servier, Siemens Healthcare, TherOx, and Valo Health; patent pending with the University of Glasgow; participation on a data safety monitoring board or advisory board for BHF PROJECT-TAVI; president of the British Society of Cardiovascular Magnetic Resonance; receipt of equipment for clinical trials from Abbott Vascular. B.R. No relevant relationships. N.R. Grant to institution from the German Ministry of Education and Research. C. Kubiak No relevant relationships. K.S.H. No relevant relationships. J.M.N. No relevant relationships. P.M.H. No relevant relationships. P.E.S. No relevant relationships. I.B. No relevant relationships. C.O. No relevant relationships. F.X.V. No relevant relationships. L.Z. No relevant relationships. V.S. No relevant relationships. A.J. No relevant relationships. F.A. No relevant relationships. M.W. No relevant relationships. D.C. No relevant relationships. I.L. No relevant relationships. E.T. No relevant relationships. M.K. No relevant relationships. A.N.N. Consulting fees from Pfizer, Boehringer Ingelheim, AstraZeneca, Novartis, and Bayer. M. Mancone No relevant relationships. D.K. No relevant relationships. G.F. No relevant relationships. M.P. No relevant relationships. V.G.R. No relevant relationships. T.D. No relevant relationships. C.D. Council member of the European Society of Hypertension; honorary treasurer of the Association of Physicians of Great Britain and Ireland; honorary treasurer of the European Council of Cardiovascular Research; vice president of SHARP Scotland; and council member of the Scottish Cardiovascular Forum. R.C. No relevant relationships. M. Fisher No relevant relationships. B.M. Grants to institution from Abbott, AstraZen-eca, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, CSL Behring, Daiichi Sankyo, Duke Clinical Institute, Eli Lilly, Medtronic, Novartis, Terumo, and Vifor Pharma; consulting fees from Abbott, AstraZeneca, Biotronik, Boehringer Ingelheim, CSL Behring, Daiichi Sankyo, Duke Clinical Institute, Medtronic, and Novartis; payment for lectures from Abbott, AstraZen-eca, Biotronik, Boehringer Ingelheim, and Novartis; national leader of the Li-brexia Program and the New Amsterdam, DAPA ACT HF-TIMI 68, MIRACLE, FINEARTS-HF, REALIZE-K, SOS-AMI, DELIVER, GARDEN-TIMI 74, ENDEAVOR, EMPACT-MI, and CARDINAL-HF trials. C. Kragelund No relevant relationships. R.A. No relevant relationships. S.K. No relevant relationships. B.G.d.B. Support to attend meeting from Europa. A.R. No relevant relationships. B.S. No relevant relationships. J.D.H. Payment for lecture from Novo Nordisk; support to attend meetings from AstraZeneca and Novo Nordisk; advisory board participation for AstraZeneca. I.R. No relevant relationships. S.R. No relevant relationships. H.C.C. No relevant relationships. I.F.É. No relevant relationships. L.L. No relevant relationships. R. Hodas No relevant relationships. A.E.N. No relevant relationships. R. Haase Research grant from the German Federal Ministry of Education and Research. S.F. No relevant relationships. M. Mohamed No relevant relationships. L.M.S.H. No relevant relationships. K.N. No relevant relationships. H.D. No relevant relationships. M.R. No relevant relationships. V.W. No relevant relationships. M.J.B. No relevant relationships. M.E. No relevant relationships. P.M. No relevant relationships. M. Bosserdt No relevant relationships. M.D. Grant from the German Research Foundation; institutional master research agreements with Siemens, GE, Philips, and Canon; patent on dynamic perfusion analysis using fractal analysis; European Society of Radiology Publications Chair and editor of Cardiac CT; counsultant to the editor of Radiology
Funding Information:
Supported by grants from the EU-FP7 Framework Programme (FP 2007-2013, EC-GA 603266) to M.D. and other grants (Berlin Institute of Health [grant from Digital Health Accelerator]; the British Heart Foundation [Centre of Research Excellence grant no. RE/18/6/34217]; Rigshospitalet, University of Copenhagen [grant and nonfinancial support]; the Deutsche Forschungsgemeinschaft [German Research Foundation] [grants from Radiomics Priority Programme: DE 1361/19-1 {428222922} and 20-1 {428223139} in SPP2177/1], and grants from the BIOQIC graduate program [GRK 2260/1 {289347353}]). The DISCHARGE trial is associated with and endorsed by DZHK (German Centre for Cardiovascular Research) and we greatly acknowledge this collaborative network. 1 The complete list of authors and affiliations is at the end of this article. Conflicts of interest are listed at the end of this article. See also the editorial by Hanneman and Gulsin in this issue.
Publisher Copyright:
© RSNA, 2024.
ID: 388022150