title: Coronary Artery Calcium as an Independent Surrogate Marker in the Risk Assessment of Patients With Atrial Fibrillation and an Intermediate Pretest Likelihood for Coronary Artery Disease Admitted to a German Chest Pain Unit.
abstract: BACKGROUND
  About 10% of patients admitted to a chest pain unit (CPU) exhibit atrial fibrillation (AF).
  
  
  OBJECTIVE
  To determine whether calcium scores (CS) are superior over common risk scores for coronary artery disease (CAD) in patients presenting with atypical chest pain, newly diagnosed AF, and intermediate pretest probability for CAD within the CPU.
  
  
  METHODS
  In 73 subjects, CS was related to the following risk scores: Global Registry of Acute Coronary Events (GRACE) score, including a new model of a frequency-normalized approach; Thrombolysis In Myocardial Infarction score; European Society of Cardiology Systematic Coronary Risk Evaluation (SCORE); Framingham risk score; and Prospective Cardiovascular Münster Study score. Revascularization rates during index stay were assessed.
  
  
  RESULTS
  Median CS was 77 (interquartile range, 1-270), with higher values in men and the left anterior descending artery. Only the modified GRACE (ρ = 0.27; P = 0.02) and the SCORE (ρ = 0.39; P < 0.005) were significantly correlated with CS, whereas the GRACE (τ = 0.21; P = 0.04) and modified GRACE (τ = 0.23; P = 0.02) scores were significantly correlated with percentile groups. Only the CS significantly discriminated between those with and without stenosis (P < 0.01).
  
  
  CONCLUSIONS
  Apart from modified GRACE score, overall correlations between risk scores and calcium burden, as well as revascularization rates during index stay, were low. By contrast, the determination of CS may be used as an additional surrogate marker in risk stratification in AF patients with intermediate pretest likelihood for CAD admitted to a CPU.
authors.affiliation: Department of Cardiology, Arnsberg Medical Center, Arnsberg, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Breuckmann
authors.affiliation: Department of Cardiovascular Medicine, University of Münster, Münster, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Olligs
authors.affiliation: Department of Anesthesiology, Arnsberg Medical Center, Arnsberg, Germany.
authors.forename: Liane
authors.initials: L
authors.lastname: Hinrichs
authors.affiliation: Department of Cardiovascular Medicine, University of Münster, Münster, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Koopmann
authors.affiliation: Department of Angiology, Arnsberg Medical Center, Arnsberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Lichtenberg
authors.affiliation: Department of Cardiology, Arnsberg Medical Center, Arnsberg, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Böse
authors.affiliation: Department of Cardiovascular Medicine, University of Münster, Münster, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Fischer
authors.affiliation: Department of Cardiovascular Medicine, University of Münster, Münster, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Eckardt
authors.affiliation: Department of Cardiovascular Medicine, University of Münster, Münster, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Waltenberger
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina.
authors.forename: J Lee
authors.initials: JL
authors.lastname: Garvey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000209:etiology*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis*; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D003661:Decision Support Techniques; D005260:Female; D005858:Germany; D006757:Hospital Units; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D061205:Vascular Calcification / Q000150:complications / Q000000981:diagnostic imaging*