Coronary artery calcium score identifies symptomatic patients with low risk for CV events
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Key takeaways:
- A low coronary artery calcium score was tied to fewer heart attacks and strokes vs. a high score in patients with stable chest pain.
- Patients with a low score may not need invasive tests or procedures.
Among patients with stable chest pain referred for invasive coronary angiography, a low coronary artery calcium score was associated with low risk for heart attack and stroke, researchers reported in Radiology.
Assessing CAC score with CT could prevent patients who ultimately do not need it from undergoing invasive procedures such as PCI or CABG, the researchers wrote.
‘A strong and independent predictor’
“Coronary artery calcium is a strong and independent predictor of cardiovascular events,” Federico Biavati, an MD/PhD candidate in the Biophysical Quantitative Imaging Towards Clinical Diagnosis (BIOQIC) research training group and a radiology resident at Charité – Universitätsmedizin Berlin, Germany, said in a press release. “The presence of coronary artery calcification indicates that atherosclerosis may have been present for some time.”
The researchers conducted a post hoc analysis of 1,749 patients (mean age, 60 years; 992 women) from the DISCHARGE trial of adults with stable chest pain referred for invasive coronary angiography. The present cohort comprised those from the trial who were randomly assigned to a CT scan whose data were available for analysis.
Patients were stratified into tertiles by CAC score: 0 (low), 1 to 399 (intermediate) or 400 or more (high). The primary outcome was major adverse CV events, defined as MI, stroke or CV death. Median follow-up was 3.5 years.
The prevalence of obstructive CAD was 4.1% in the low group, 29.7% in the intermediate group and 76.1% in the high group (P < .001). The prevalence of high-risk obstructive CAD, defined as three-vessel disease, left main coronary artery stenosis, proximal left anterior descending coronary artery stenosis or the combination of any of those, was 1.1% in the low group, 14.3% in the intermediate group and 51% in the high group (P < .001), according to the researchers.
Revascularization was far more common in the high group than the low group (46.2% vs. 1.7%; P < .001), Biavati and colleagues wrote.
The primary outcome occurred in 0.5% of the low group, 1.9% of the intermediate group and 6.8% of the high group (HR for low vs. high = 0.08; 95% CI, 0.02-0.3; P < .001; HR for intermediate vs. high = 0.27; 95% CI, 0.13-0.59; P = .001), with no difference by sex (P for interaction = .68), the researchers found.
CAC score role in patient management
“This finding may indicate that a zero coronary artery calcium score can play a larger role in patient management strategies,” Marc Dewey, MD, professor and vice chair of radiology at Charité, said in the release. “The findings suggest that patients with stable chest pain and a coronary artery calcium score of zero may not require invasive coronary angiography using cardiac catheterization because the risk of cardiovascular events is so low.”
In a related editorial, Kate Hanneman, MD, MPH, associate professor and vice chair of research at the University of Toronto and a clinician scientist at the Toronto General Hospital Research Institute, and Gaurav Gulsin, MBChD, PhD, a National Institute for Health and Care Research (NIHR) academic clinical lecturer in cardiology at the University of Leicester, U.K., wrote that “the authors should be commended for advancing our understanding of the prognostic value of CAC scores in symptomatic patients with stable chest pain and clinical indication for invasive angiography,” but that clinicians must keep in mind that a small number of patients with a CAC score of 0 do have obstructive CAD and do experience MACE, so overall coronary CT angiography results must be considered.
References:
- Coronary artery calcium score predictive of heart attacks, strokes. https://www.rsna.org/news/2024/march/cac-predicts-heart-attacks-and-strokes. Published March 5, 2024. Accessed March 5, 2024.
- Hanneman K, et al. Radiology. 2024;doi:10.1148/radiol.240073.
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