title: Additive prognostic value of coronary artery calcium score over coronary computed tomographic angiography stenosis assessment in symptomatic patients without known coronary artery disease.
abstract: The objective of this study was to examine the additive prognostic performance of coronary artery calcium score (CACS) over coronary computed tomography angiography (CCTA) stenosis assessment in symptomatic patients suspected for coronary artery disease (CAD) undergoing CCTA. A total of 805 symptomatic patients without known history of CAD who underwent coronary evaluation by multidetector cardiac CT were analyzed. Mean age of the cohort was 58 ± 13 years. A total of 44% (354 of 805) of the patients had a 0 CACS, 27% (215 of 805) had CACS 1 to 100, 14% (111 of 805) had CACS 101 to 400, and 15% (125 of 805) had CACS >400. CCTA showed normal coronary arteries in 43% (349 of 805) of patients, ≤50% stenosis in 42% (333 of 805), and >50% stenosis in 15% (123 of 805). Patients were followed for 2.3 ± 0.9 years. Major adverse cardiac event (MACE) was defined as cardiac death, nonfatal myocardial infarction, and late coronary revascularization. Overall incidence of MACE was 1.4% per year. Both CACS and CCTA stenosis were independently associated with increased MACE (p <0.05 for both). Addition of CACS into the model with clinical risk factors and CCTA stenosis significantly improved predictive performance for MACE from the model with clinical risk factors and CCTA stenosis only (global chi-square score 108 vs 70; p = 0.019). In conclusion; in symptomatic patients without known CAD, both CACS and CCTA stenosis were independently associated with increased cardiac events, and performing non-contrast-enhanced CACS evaluation in addition to contrast-enhanced CCTA improved predictive ability for future cardiac events compared to CCTA stenosis assessment alone.
authors.affiliation: Department of Medicine, Houston Methodist Hospital, Houston, Texas. Electronic address: kchaikriangkrai@houstonmethodist.org.
authors.forename: Kongkiat
authors.initials: K
authors.lastname: Chaikriangkrai
authors.affiliation: Department of Medicine, Houston Methodist Hospital, Houston, Texas.
authors.forename: Pradnya
authors.initials: P
authors.lastname: Velankar
authors.affiliation: Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Robert
authors.initials: R
authors.lastname: Schutt
authors.affiliation: Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Sama
authors.initials: S
authors.lastname: Alchalabi
authors.affiliation: Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Faisal
authors.initials: F
authors.lastname: Nabi
authors.affiliation: Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: John
authors.initials: J
authors.lastname: Mahmarian
authors.affiliation: Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Su Min
authors.initials: SM
authors.lastname: Chang
mesh_terms: D000368:Aged; D002118:Calcium / Q000378:metabolism; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000401:mortality
chemical_list: D002118:Calcium