Incremental prognostic value of coronary artery calcium score versus CT angiography among symptomatic patients without known coronary artery disease

Edward Hulten, Marcio Sommer Bittencourt, Brian Ghoshhajra, Daniel O'Leary, Mitalee P. Christman, Michael J. Blaha, Quynh Truong, Kyle Nelson, Philip Montana, Michael Steigner, Frank Rybicki, Jon Hainer, Thomas J. Brady, Udo Hoffmann, Marcelo F. Di Carli, Khurram Nasir, Suhny Abbara, Ron Blankstein

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Objective: To evaluate the prognostic value and test characteristics of coronary artery calcium (CAC) score for the identification of obstructive coronary artery disease (CAD) in comparison with coronary computed tomography angiography (CCTA) among symptomatic patients. Methods: Retrospective cohort study at two large hospitals, including all symptomatic patients without prior CAD who underwent both CCTA and CAC. Accuracy of CAC for the identification of ≥50% and ≥70% stenosis by CCTA was evaluated. Prognostic value of CAC and CCTA were compared for prediction of major adverse cardiovascular events (MACE, defined as non-fatal myocardial infarction, cardiovascular death, late coronary revascularization (>90 days), and unstable angina requiring hospitalization). Results: Among 1145 included patients, the mean age was 55±12 years and median follow up 2.4 (IQR: 1.5-3.5) years. Overall, 406 (35%) CCTA were normal, 454 (40%) had <50% stenosis, and 285 (25%) had ≥50% stenosis. The prevalence of ≥70% stenosis was 16%. Among 483 (42%) patients with CAC zero, 395 (82%) had normal CCTA, 81 (17%) <50% stenosis, and 7 (1.5%)≥50% stenosis. 2 (0.4%) patients had ≥70% stenosis. For diagnosis of ≥50% stenosis, CAC had a sensitivity of 98% and specificity of 55%. The negative predictive value (NPV) for CAC was 99% for ≥50% stenosis and 99.6% for ≥70% stenosis by CCTA. There were no adverse events among the 7 patients with zero calcium and ≥50% CAD. For prediction of MACE, the c-statistic for clinical risk factors of 0.62 increased to 0.73 (p<0.001) with CAC versus 0.77 (p=0.02) with CCTA. Conclusion: Among symptomatic patients with CAC zero, a 1-2% prevalence of potentially obstructive CAD occurs, although this finding was not associated with future coronary revascularization or adverse prognosis within 2 years.

Original languageEnglish (US)
Pages (from-to)190-195
Number of pages6
JournalAtherosclerosis
Volume233
Issue number1
DOIs
StatePublished - Mar 2014

Fingerprint

Coronary Artery Disease
Coronary Vessels
Calcium
Pathologic Constriction
Coronary Stenosis
Computed Tomography Angiography
Unstable Angina
Hospitalization
Cohort Studies
Retrospective Studies
Myocardial Infarction
Sensitivity and Specificity

Keywords

  • Atherosclerosis
  • Coronary artery calcium score
  • Coronary computed tomography angiography
  • Epidemiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Incremental prognostic value of coronary artery calcium score versus CT angiography among symptomatic patients without known coronary artery disease. / Hulten, Edward; Bittencourt, Marcio Sommer; Ghoshhajra, Brian; O'Leary, Daniel; Christman, Mitalee P.; Blaha, Michael J.; Truong, Quynh; Nelson, Kyle; Montana, Philip; Steigner, Michael; Rybicki, Frank; Hainer, Jon; Brady, Thomas J.; Hoffmann, Udo; Di Carli, Marcelo F.; Nasir, Khurram; Abbara, Suhny; Blankstein, Ron.

In: Atherosclerosis, Vol. 233, No. 1, 03.2014, p. 190-195.

Research output: Contribution to journalArticle

Hulten, E, Bittencourt, MS, Ghoshhajra, B, O'Leary, D, Christman, MP, Blaha, MJ, Truong, Q, Nelson, K, Montana, P, Steigner, M, Rybicki, F, Hainer, J, Brady, TJ, Hoffmann, U, Di Carli, MF, Nasir, K, Abbara, S & Blankstein, R 2014, 'Incremental prognostic value of coronary artery calcium score versus CT angiography among symptomatic patients without known coronary artery disease', Atherosclerosis, vol. 233, no. 1, pp. 190-195. https://doi.org/10.1016/j.atherosclerosis.2013.12.029
Hulten, Edward ; Bittencourt, Marcio Sommer ; Ghoshhajra, Brian ; O'Leary, Daniel ; Christman, Mitalee P. ; Blaha, Michael J. ; Truong, Quynh ; Nelson, Kyle ; Montana, Philip ; Steigner, Michael ; Rybicki, Frank ; Hainer, Jon ; Brady, Thomas J. ; Hoffmann, Udo ; Di Carli, Marcelo F. ; Nasir, Khurram ; Abbara, Suhny ; Blankstein, Ron. / Incremental prognostic value of coronary artery calcium score versus CT angiography among symptomatic patients without known coronary artery disease. In: Atherosclerosis. 2014 ; Vol. 233, No. 1. pp. 190-195.
@article{113dc12719fa4b5bb882a6fadc87a115,
title = "Incremental prognostic value of coronary artery calcium score versus CT angiography among symptomatic patients without known coronary artery disease",
abstract = "Objective: To evaluate the prognostic value and test characteristics of coronary artery calcium (CAC) score for the identification of obstructive coronary artery disease (CAD) in comparison with coronary computed tomography angiography (CCTA) among symptomatic patients. Methods: Retrospective cohort study at two large hospitals, including all symptomatic patients without prior CAD who underwent both CCTA and CAC. Accuracy of CAC for the identification of ≥50{\%} and ≥70{\%} stenosis by CCTA was evaluated. Prognostic value of CAC and CCTA were compared for prediction of major adverse cardiovascular events (MACE, defined as non-fatal myocardial infarction, cardiovascular death, late coronary revascularization (>90 days), and unstable angina requiring hospitalization). Results: Among 1145 included patients, the mean age was 55±12 years and median follow up 2.4 (IQR: 1.5-3.5) years. Overall, 406 (35{\%}) CCTA were normal, 454 (40{\%}) had <50{\%} stenosis, and 285 (25{\%}) had ≥50{\%} stenosis. The prevalence of ≥70{\%} stenosis was 16{\%}. Among 483 (42{\%}) patients with CAC zero, 395 (82{\%}) had normal CCTA, 81 (17{\%}) <50{\%} stenosis, and 7 (1.5{\%})≥50{\%} stenosis. 2 (0.4{\%}) patients had ≥70{\%} stenosis. For diagnosis of ≥50{\%} stenosis, CAC had a sensitivity of 98{\%} and specificity of 55{\%}. The negative predictive value (NPV) for CAC was 99{\%} for ≥50{\%} stenosis and 99.6{\%} for ≥70{\%} stenosis by CCTA. There were no adverse events among the 7 patients with zero calcium and ≥50{\%} CAD. For prediction of MACE, the c-statistic for clinical risk factors of 0.62 increased to 0.73 (p<0.001) with CAC versus 0.77 (p=0.02) with CCTA. Conclusion: Among symptomatic patients with CAC zero, a 1-2{\%} prevalence of potentially obstructive CAD occurs, although this finding was not associated with future coronary revascularization or adverse prognosis within 2 years.",
keywords = "Atherosclerosis, Coronary artery calcium score, Coronary computed tomography angiography, Epidemiology",
author = "Edward Hulten and Bittencourt, {Marcio Sommer} and Brian Ghoshhajra and Daniel O'Leary and Christman, {Mitalee P.} and Blaha, {Michael J.} and Quynh Truong and Kyle Nelson and Philip Montana and Michael Steigner and Frank Rybicki and Jon Hainer and Brady, {Thomas J.} and Udo Hoffmann and {Di Carli}, {Marcelo F.} and Khurram Nasir and Suhny Abbara and Ron Blankstein",
year = "2014",
month = "3",
doi = "10.1016/j.atherosclerosis.2013.12.029",
language = "English (US)",
volume = "233",
pages = "190--195",
journal = "Atherosclerosis",
issn = "0021-9150",
publisher = "Elsevier Ireland Ltd",
number = "1",

}

TY - JOUR

T1 - Incremental prognostic value of coronary artery calcium score versus CT angiography among symptomatic patients without known coronary artery disease

AU - Hulten, Edward

AU - Bittencourt, Marcio Sommer

AU - Ghoshhajra, Brian

AU - O'Leary, Daniel

AU - Christman, Mitalee P.

AU - Blaha, Michael J.

AU - Truong, Quynh

AU - Nelson, Kyle

AU - Montana, Philip

AU - Steigner, Michael

AU - Rybicki, Frank

AU - Hainer, Jon

AU - Brady, Thomas J.

AU - Hoffmann, Udo

AU - Di Carli, Marcelo F.

AU - Nasir, Khurram

AU - Abbara, Suhny

AU - Blankstein, Ron

PY - 2014/3

Y1 - 2014/3

N2 - Objective: To evaluate the prognostic value and test characteristics of coronary artery calcium (CAC) score for the identification of obstructive coronary artery disease (CAD) in comparison with coronary computed tomography angiography (CCTA) among symptomatic patients. Methods: Retrospective cohort study at two large hospitals, including all symptomatic patients without prior CAD who underwent both CCTA and CAC. Accuracy of CAC for the identification of ≥50% and ≥70% stenosis by CCTA was evaluated. Prognostic value of CAC and CCTA were compared for prediction of major adverse cardiovascular events (MACE, defined as non-fatal myocardial infarction, cardiovascular death, late coronary revascularization (>90 days), and unstable angina requiring hospitalization). Results: Among 1145 included patients, the mean age was 55±12 years and median follow up 2.4 (IQR: 1.5-3.5) years. Overall, 406 (35%) CCTA were normal, 454 (40%) had <50% stenosis, and 285 (25%) had ≥50% stenosis. The prevalence of ≥70% stenosis was 16%. Among 483 (42%) patients with CAC zero, 395 (82%) had normal CCTA, 81 (17%) <50% stenosis, and 7 (1.5%)≥50% stenosis. 2 (0.4%) patients had ≥70% stenosis. For diagnosis of ≥50% stenosis, CAC had a sensitivity of 98% and specificity of 55%. The negative predictive value (NPV) for CAC was 99% for ≥50% stenosis and 99.6% for ≥70% stenosis by CCTA. There were no adverse events among the 7 patients with zero calcium and ≥50% CAD. For prediction of MACE, the c-statistic for clinical risk factors of 0.62 increased to 0.73 (p<0.001) with CAC versus 0.77 (p=0.02) with CCTA. Conclusion: Among symptomatic patients with CAC zero, a 1-2% prevalence of potentially obstructive CAD occurs, although this finding was not associated with future coronary revascularization or adverse prognosis within 2 years.

AB - Objective: To evaluate the prognostic value and test characteristics of coronary artery calcium (CAC) score for the identification of obstructive coronary artery disease (CAD) in comparison with coronary computed tomography angiography (CCTA) among symptomatic patients. Methods: Retrospective cohort study at two large hospitals, including all symptomatic patients without prior CAD who underwent both CCTA and CAC. Accuracy of CAC for the identification of ≥50% and ≥70% stenosis by CCTA was evaluated. Prognostic value of CAC and CCTA were compared for prediction of major adverse cardiovascular events (MACE, defined as non-fatal myocardial infarction, cardiovascular death, late coronary revascularization (>90 days), and unstable angina requiring hospitalization). Results: Among 1145 included patients, the mean age was 55±12 years and median follow up 2.4 (IQR: 1.5-3.5) years. Overall, 406 (35%) CCTA were normal, 454 (40%) had <50% stenosis, and 285 (25%) had ≥50% stenosis. The prevalence of ≥70% stenosis was 16%. Among 483 (42%) patients with CAC zero, 395 (82%) had normal CCTA, 81 (17%) <50% stenosis, and 7 (1.5%)≥50% stenosis. 2 (0.4%) patients had ≥70% stenosis. For diagnosis of ≥50% stenosis, CAC had a sensitivity of 98% and specificity of 55%. The negative predictive value (NPV) for CAC was 99% for ≥50% stenosis and 99.6% for ≥70% stenosis by CCTA. There were no adverse events among the 7 patients with zero calcium and ≥50% CAD. For prediction of MACE, the c-statistic for clinical risk factors of 0.62 increased to 0.73 (p<0.001) with CAC versus 0.77 (p=0.02) with CCTA. Conclusion: Among symptomatic patients with CAC zero, a 1-2% prevalence of potentially obstructive CAD occurs, although this finding was not associated with future coronary revascularization or adverse prognosis within 2 years.

KW - Atherosclerosis

KW - Coronary artery calcium score

KW - Coronary computed tomography angiography

KW - Epidemiology

UR - http://www.scopus.com/inward/record.url?scp=84893819657&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84893819657&partnerID=8YFLogxK

U2 - 10.1016/j.atherosclerosis.2013.12.029

DO - 10.1016/j.atherosclerosis.2013.12.029

M3 - Article

C2 - 24529143

AN - SCOPUS:84893819657

VL - 233

SP - 190

EP - 195

JO - Atherosclerosis

JF - Atherosclerosis

SN - 0021-9150

IS - 1

ER -