Increased discordance between HeartScore and coronary artery calcification score after introduction of the new ESC prevention guidelines

Diederichsen, Axel Cosmus Pyndt; Mahabadi, Amir-Abbas; Gerke, Oke; Lehmann, Nils; Sand, Niels Peter Rønnow; Moebus, Susanne; Lambrechtsen, Jess; Kälsch, Hagen; Jensen, Jesper Møller; Jöckel, Karl‐Heinz; Mickley, Hans; Erbel, Raimund

doi:10.1016/j.atherosclerosis.2015.01.005

Cited by 11 publications

(6 citation statements)

References 29 publications

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“…In external cohorts, there are uncaptured genetic and environmental risk factors as well as variations in risk over time that diminish the performance of a risk estimator compared to the derivation cohort. This heterogeneity in risk mimics the heterogeneity in atherogenesis, and is a key finding of the study in the previous issue of Atherosclerosis by Diederichsen et al [13].…”

supporting

confidence: 54%

“…In this important study, Diederichsen of recent changes in the European HeartScore risk estimator in more than 2700 German individuals and more than 1100 Danish subjects between the ages of 45 and 65 years from the Heinz Nixdorf Recall and Danish Risk Score studies [13]. The motivation for this analysis was a recent change in the HeartScore model for Germany and Denmark from high-risk to low-risk countries based on declines in CVD in those countries below an arbitrary threshold [2].…”

mentioning

confidence: 99%

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The highs and lows of cardiovascular risk prediction: Time for paradigm shift?

Joshi¹,

Nasir²

2015

Atherosclerosis

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confidence: 54%

mentioning

confidence: 99%

The highs and lows of cardiovascular risk prediction: Time for paradigm shift?

Joshi¹,

Nasir²

2015

Atherosclerosis

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“…While there is evidence that traditional risk factors are associated with an increase in arterial calcification [3], others report on a discrepancy between traditional risk factors and coronary artery calcification when countries are downgraded as low-risk countries. Diederichsen et al showed through the example of Germany and Denmark using low-risk models, that individuals with severe coronary atherosclerosis are more commonly assigned to low to intermediate pre-test probability of CAD [4]. The absence of CAC is associated with low rates of cardiovascular events such as myocardial infarction, cardiovascular death, or unstable angina pectoris in asymptomatic individuals [5].…”

Section: Introductionmentioning

confidence: 99%

Computed tomography angiography versus Agatston score for diagnosis of coronary artery disease in patients with stable chest pain: individual patient data meta-analysis of the international COME-CCT Consortium

et al. 2022

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Objectives There is conflicting evidence about the comparative diagnostic accuracy of the Agatston score versus computed tomography angiography (CTA) in patients with suspected obstructive coronary artery disease (CAD). Purpose To determine whether CTA is superior to the Agatston score in the diagnosis of CAD. Methods In total 2452 patients with stable chest pain and a clinical indication for invasive coronary angiography (ICA) for suspected CAD were included by the Collaborative Meta-analysis of Cardiac CT (COME-CCT) Consortium. An Agatston score of > 400 was considered positive, and obstructive CAD defined as at least 50% coronary diameter stenosis on ICA was used as the reference standard. Results Obstructive CAD was diagnosed in 44.9% of patients (1100/2452). The median Agatston score was 74. Diagnostic accuracy of CTA for the detection of obstructive CAD (81.1%, 95% confidence interval [CI]: 77.5 to 84.1%) was significantly higher than that of the Agatston score (68.8%, 95% CI: 64.2 to 73.1%, p < 0.001). Among patients with an Agatston score of zero, 17% (101/600) had obstructive CAD. Diagnostic accuracy of CTA was not significantly different in patients with low to intermediate (1 to < 100, 100–400) versus moderate to high Agatston scores (401–1000, > 1000). Conclusions Results in our international cohort show CTA to have significantly higher diagnostic accuracy than the Agatston score in patients with stable chest pain, suspected CAD, and a clinical indication for ICA. Diagnostic performance of CTA is not affected by a higher Agatston score while an Agatston score of zero does not reliably exclude obstructive CAD. Key Points • CTA showed significantly higher diagnostic accuracy (81.1%, 95% confidence interval [CI]: 77.5 to 84.1%) for diagnosis of coronary artery disease when compared to the Agatston score (68.8%, 95% CI: 64.2 to 73.1%, p < 0.001). • Diagnostic performance of CTA was not affected by increased amount of calcium and was not significantly different in patients with low to intermediate (1 to <100, 100–400) versus moderate to high Agatston scores (401–1000, > 1000). • Seventeen percent of patients with an Agatston score of zero showed obstructive coronary artery disease by invasive angiography showing absence of coronary artery calcium cannot reliably exclude coronary artery disease.

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“…These tools are based on demographic and clinical risk factors with a proven prognostic impact in population-based analysis. Although some authors were able to show that the risk stratification with SCORE leads to beneficial changes in medication during follow-up, others failed to find an association between the SCORE and coronary artery calcium [19,20]. Although some authors were able to show that the risk stratification with SCORE leads to beneficial changes in medication during follow-up, others failed to find an association between the SCORE and coronary artery calcium [19,20].…”

Section: Discussionmentioning

confidence: 99%

Low previous cardiovascular risk of patients with ST-elevation myocardial infarction

Rodrigues

Gonçalves

Costa

et al. 2017

Coronary Artery Disease

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In a population of patients with STEMI as the first manifestation of CAD, the CV risk stratification with the SCORE risk charts, if calculated before the event, would classify as low risk more than two-thirds of the patients (71.4%) and only 3.5% would be classified as very high-risk patients. The high prevalence of low-risk patients indicates the current challenge of CV risk stratification, underlying the need for additional tools in primary prevention to better identify patients at risk.

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Increased discordance between HeartScore and coronary artery calcification score after introduction of the new ESC prevention guidelines

Cited by 11 publications

References 29 publications

The highs and lows of cardiovascular risk prediction: Time for paradigm shift?

The highs and lows of cardiovascular risk prediction: Time for paradigm shift?

Computed tomography angiography versus Agatston score for diagnosis of coronary artery disease in patients with stable chest pain: individual patient data meta-analysis of the international COME-CCT Consortium

Low previous cardiovascular risk of patients with ST-elevation myocardial infarction

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