Interplay of Risk Factors and Coronary Artery Calcium for CHD Risk in Young Patients

Mortensen, Martin Bødtker; Dzaye, Omar; Bødtker, Henrik; Steffensen, Flemming Hald; Bøtker, Hans Erik; Jensen, Jesper Møller; Sand, Niels Peter Rønnow; Mæng, Michael; Olesen, Kevin Kris Warnakula; Sørensen, Henrik Toft; Kanstrup, Helle; Blankstein, Ron; Blaha, Michael J.; Nørgaard, Bjarne Linde

doi:10.1016/j.jcmg.2021.05.003

Cited by 23 publications

(14 citation statements)

References 22 publications

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“…Although the diagnostic and prognostic value of CACS have been established [ 30 , 31 ], extensive literature has repeatedly demonstrated the strong interplay between CACS and risk factors for predicting the presence of obstructive CAD and for future MACE [ 17 , 32 – 34 ]. In conformity with previous findings comparing CACS-based PTP models to other models [ 4 , 6 ], we demonstrated that CACS-CL model offered precise estimation of PTP and prediction of MACE.…”

Section: Discussionmentioning

confidence: 99%

Comparison of risk assessment strategies incorporating coronary artery calcium score with estimation of pretest probability to defer cardiovascular testing in patients with stable chest pain

Meng

Jiang

Ren

et al. 2023

BMC Cardiovasc Disord

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Background The risk assessment of patients with stable chest pain (SCP) to defer further cardiovascular testing is crucial, but the most appropriate risk assessment strategy remains unknown. We aimed to compare current strategies to identify low risk SCP patients. Methods 5289 symptomatic patients who had undergone coronary artery calcium score (CACS) and coronary computed tomographic angiography scan were identified and followed. Pretest probability (PTP) of obstructive coronary artery disease (CAD) for every patient was estimated according to European Society of Cardiology (ESC)-PTP model and CACS-weighted clinical likelihood (CACS-CL) model, respectively. Based on the 2019 ESC guideline-determined risk assessment strategy (ESC strategy) and CACS-CL model-based risk assessment strategy (CACS-CL strategy), all patients were divided into low and high risk group, respectively. Area under receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI) and net reclassification improvement (NRI) was used. Results CACS-CL model provided more robust estimation of PTP than ESC-PTP model did, with a larger AUC (0.838 versus 0.735, p < 0.0001), positive IDI (9%, p < 0.0001) and less discrepancy between observed and predicted probabilities. As a result, compared to ESC strategy which only applied CACS-CL model to patients with borderline ESC-PTP, CACS-CL strategy incorporating CACS with estimation of PTP to entire SCP patients indicated a positive NRI (19%, p < 0.0001) and a stronger association to major adverse cardiovascular events, with hazard ratios: 3.97 (95% confidence intervals: 2.75–5.72) versus 5.11 (95% confidence intervals: 3.40–7.69). Conclusion The additional use of CACS for all SCP patients in CACS-CL strategy improved the risk assessment of SCP patients to identify individuals at low risk.

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Section: Discussionmentioning

confidence: 99%

Comparison of risk assessment strategies incorporating coronary artery calcium score with estimation of pretest probability to defer cardiovascular testing in patients with stable chest pain

Meng

Jiang

Ren

et al. 2023

BMC Cardiovasc Disord

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“…While traditional CAC scoring recommendations begin at the age of 45 years, the ASCVD burden among SA individuals begins roughly 10 years earlier than in other racial and ethnic groups and argues for earlier screening. As such, after risk assessment, implementation of CAC testing, particularly in those with significant risk factors or a family history of CHD may aid in the detection and management of subclinical atherosclerosis [48] , [49] , [50] , [51] . Table 2 summarizes the key recommendations for CAC scoring in SA patients.…”

Section: Discussionmentioning

confidence: 99%

Leveling the playing field: The utility of coronary artery calcium scoring in cardiovascular risk stratification in South Asians

Agarwala¹,

Patel²,

Blaha³

et al. 2023

American Journal of Preventive Cardiology

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“…Advanced CAC measures such as vessel involvement, density, and volume in SAs are summarized in Table 4 . 169 , 170 , 248 - 253 Overall, ASCVD event data are required to confirm the importance of these findings. 254 - 258 …”

Section: Coronary Artery Calciummentioning

confidence: 99%

Identification and Management of Atherosclerotic Cardiovascular Disease Risk in South Asian Populations in the U.S.

Agarwala¹,

Satish²,

Rifai³

et al. 2023

JACC: Advances

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Interplay of Risk Factors and Coronary Artery Calcium for CHD Risk in Young Patients

Cited by 23 publications

References 22 publications

Comparison of risk assessment strategies incorporating coronary artery calcium score with estimation of pretest probability to defer cardiovascular testing in patients with stable chest pain

Comparison of risk assessment strategies incorporating coronary artery calcium score with estimation of pretest probability to defer cardiovascular testing in patients with stable chest pain

Leveling the playing field: The utility of coronary artery calcium scoring in cardiovascular risk stratification in South Asians

Identification and Management of Atherosclerotic Cardiovascular Disease Risk in South Asian Populations in the U.S.

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