Objective-To assess the association between cardiovascular risk factors and extent of noncalcified-(NCAP), mixed-(MCAP), and calcified coronary atherosclerotic plaque (CAP). Methods and Results-In this cross-sectional study, we included consecutive subjects who presented with chest pain but had no history of coronary artery disease (CAD) and did not develop acute coronary syndrome. Although useful, the predictive value of these tools is limited as approximately 20% of cardiovascular events occur in the absence of any major risk factor, 3 and at least one risk factor can be found in the majority of individuals who do not experience cardiovascular events. 4 There is strong evidence that information on the presence and extent of calcified coronary atherosclerotic plaque (CAP) is independent and incremental to traditional risk assessment for the prediction of cardiovascular events. 5 Whereas assessment of CAP is performed using noncontrast coronary CT imaging, recent data indicate that contrast-enhanced data acquisition using advanced multidetector (MDCT) technology permits the detection of noncalcified coronary atherosclerotic plaque (NCAP) in addition to CAP in good agreement with intravascular ultrasound (IVUS). 6,7 Although previous studies indicate that the amount of CAP is highly related to the overall plaque burden, it represents only approximately 20% of the total atherosclerotic plaque burden 8 and is thought to be present in the advanced stages of atherosclerosis within an individual plaque whereas NCAP is considered to be a feature of early atherosclerosis. 9 Furthermore, there is growing evidence suggesting that NCAP might be associated with acute coronary syndrome. 10,11 However, whether the relation of CAP to NCAP is dependent of age, and whether the presence and extent of NCAP, mixed coronary atherosclerotic plaque (MCAP), and CAP are similarly associated with cardiovascular risk factors remains unclear.Thus, we performed a cross-sectional study to systematically assess the association between cardiovascular risk Original

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Objectives Cardiac multidetector computed tomography (CMCT) has potential to be used as a screening test for patients with acute chest pain, but several tools are already used to risk-stratify this population. Risk models exist that stratify need for intensive-care (Goldman), short-term prognosis (Thrombolysis in Myocardial Infarction, TIMI), and one-year events (Sanchis). We applied these cardiovascular risk models to candidates for CMCT and assessed sensitivity for prediction of in-hospital NSTEMI. We hypothesized that none of the models would achieve a sensitivity of 90% or greater, thereby justifying use of CMCT in patients with acute chest pain. Methods We analyzed TIMI, Goldman, and Sanchis in 148 consecutive patients with chest pain, non-diagnostic ECG, and negative initial cardiac biomarkers who previously met inclusion and exclusion criteria for the ROMICAT Study. NSTEMI was adjudicated and risk scores were categorized based on established criteria. Risk score agreement was assessed with weighted kappa statistics. Results Overall 17/148 (11%) patients had NSTEMI. For all risk models, sensitivity was poor (range 35–53%) and 95% confidence intervals did not cross above 77%. Agreement to risk-classify patients was poor to moderate (weighted kappa range 0.18–0.43). Patients categorized as “low risk” had non-zero rates of NSTEMI using all three scoring models (range 8–9%). Conclusions Available risk scores had poor sensitivity to detect NSTEMI in patients with acute chest pain. Because of the small number of patients in this data set, these findings require confirmation in larger studies.