The coronary calcium score is a more accurate predictor of significant coronary stenosis than conventional risk factors in symptomatic patients: Euro-CCAD study

Nicoll, Rachel; Wiklund, Urban; Zhao, Yan; Diederichsen, Axel Cosmus Pyndt; Mickley, Hans; Øvrehus, Kristian Altern; Zamorano, Pepe; Guéret, Pascal; Schmermund, Axel; Maffei, Erica; Cademartiri, Filippo; Budoff, Matthew J.; Henein, Michael Y.

doi:10.1016/j.ijcard.2016.01.056

Cited by 44 publications

(40 citation statements)

References 33 publications

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“…Our findings are consistent with the recent Euro‐Calcific Coronary Artery Disease (CCAD) study, which showed in a cohort of patients with angina symptoms at intermediate risk for coronary heart disease that CACS was the most powerful predictor of ≥50% coronary artery stenosis compared to conventional risk factors. In this study, combination of CACS and conventional risk factors significantly improved the prediction of ≥50% coronary artery stenosis irrespective of the method used for diagnosis of stenosis (conventional angiography or CT coronary angiography) …”

Section: Discussionmentioning

confidence: 72%

“…In this study, combination of CACS and conventional risk factors significantly improved the prediction of ≥50% coronary artery stenosis irrespective of the method used for diagnosis of stenosis (conventional angiography or CT coronary angiography). 13 Moreover, CACS is also a strong predictor of cardiovascular events. 10 CACS was shown to be the best novel risk factor of a first cardiovascular event in patients at intermediate risk of cardiovascular events based on the Framingham Risk Score.…”

Section: Discussionmentioning

confidence: 99%

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Coronary Artery Calcium Score Improves the Prediction of Occult Coronary Artery Stenosis in Ischemic Stroke Patients

Beigneux

Sablayrolles

Varenne

et al. 2016

JAHA

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BackgroundCoronary heart disease is a significant cause of morbidity and mortality in stroke patients. The coronary artery calcium score (CACS) has emerged as a robust and noninvasive predictor of coronary events. We assessed the predictive ability of CACS to identify stroke patients with severe (≥50%) occult coronary artery stenosis in a stroke/transient ischemic attack population, in addition to the PRECORIS score, based on Framingham Risk Score and presence of cervicocephalic artery stenosis, which was derived and validated for that purpose.Methods and ResultsWe enrolled consecutive patients aged 45 to 75 years referred to our stroke unit with noncardioembolic ischemic stroke or transient ischemic attack, and no prior history of coronary disease. The presence of coronary stenosis was assessed with 64‐section computed tomography coronary angiography, and all patients had a detailed etiological work‐up. CACS was determined from computed tomography measurement using the Agatson score. The predictive value of CACS was assessed by logistic regression and reclassification method. Among 300 patients included in the study, 274 had computed tomography coronary angiography. Fifty patients (18%) had at least 1 coronary artery stenosis ≥50%. In multivariable analysis, after adjustment for the PRECORIS score, CACS was strongly associated with the presence of occult coronary artery stenosis (odds ratio=14.8 [1.8–120.3] for CACS [1–100] and 70.9 [8.9–562.0] for CACS >100). When CACS was added to the standard model, model fit was improved (P<0.001), Net Reclassification Improvement was 28.2% (P<0.001), and Integrated Discrimination Index was 18.2% (P<0.001).ConclusionsIn stroke/transient ischemic attack patients, CACS improves the prediction of occult coronary stenosis beyond classical risk factors.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Coronary Artery Calcium Score Improves the Prediction of Occult Coronary Artery Stenosis in Ischemic Stroke Patients

Beigneux

Sablayrolles

Varenne

et al. 2016

JAHA

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“…17 An exercise ECG was considered positive if there were ST-segment changes consistent with ischemia during stress or early termination (<3 minutes) due to reproduction of symptoms, arrhythmia, and/or hypotension. A stress echocardiography or stress nuclear test was considered positive if there was any inducible ischemia in at least one coronary territory (anterior, inferior, or lateral) or early termination of exercise stress (<3 minutes) due to ST-segment changes consistent with ischemia, symptom reproduction, arrhythmia, and/or hypotension.…”

Section: Methodsmentioning

confidence: 99%

Prognostic Value of Coronary Artery Calcium in the PROMISE Study (Prospective Multicenter Imaging Study for Evaluation of Chest Pain)

et al. 2017

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Background Coronary artery calcium (CAC) is an established predictor of future major adverse atherosclerotic cardiovascular events in asymptomatic individuals. However limited data exist as to how CAC compares to functional testing (FT) in estimating prognosis in symptomatic patients. Methods In the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial, patients with stable chest pain (or dyspnea) and intermediate pre-test probability for obstructive coronary artery disease (CAD) were randomized to FT (exercise electrocardiography, nuclear stress, or stress echocardiography) or anatomic testing. We evaluated those who underwent CAC testing as part of the anatomic evaluation (n=4,209) and compared to results of FT (n=4,602). We stratified CAC and FT results as normal or mildly, moderately or severely abnormal (for CAC: 0, 1–99 Agatston Score [AS], 100–400 AS and >400 AS, respectively; for FT: normal, mild=late positive treadmill, moderate=early positive treadmill or single-vessel ischemia and severe=large ischemic region abnormality). The primary endpoint was all-cause death, myocardial infarction or unstable angina hospitalization over a median follow-up of 26.1 months. Cox regression models were used to calculate hazard ratios and C-statistic to determine predictive and discriminatory value. Results Overall, the distribution of normal or mildly, moderately or severely abnormal test results was significantly different between FT and CAC (FT = normal 3588 [78.0%], mild 432 [9.4%], moderate 217 [4.7%], severe 365 [7.9%]; CAC = normal 1,457 [34.6%], mild 1340 [31.8%], moderate 772 [18.3%], severe 640 [15.2%], p <0.0001). Moderate and severe abnormalities in both arms robustly predicted events (moderate: CAC HR 3.14, 95% CI 1.81–5.44 and FT HR 2.65, 95% CI 1.46–4.83; severe: CAC HR 3.56, 95% CI 1.99–6.36 and FT HR 3.88, 95% CI 2.58–5.85. In the CAC arm, the majority of events (n=112/133; 84%) occurred in patients with any positive CAC test (score >0) whereas less than half of events occurred in patients with mild, moderate or severely abnormal FT (n=57/132; 43%) (p<0.001). In contrast, any abnormality on FT was significantly more specific for predicting events (78.6% for FT vs 35.2% for CAC, p<0.001). Overall discriminatory ability in predicting the primary endpoint of mortality, nonfatal myocardial infarction, and unstable angina hospitalization was similar and fair for both CAC and FT (c-statistic, 0.67 vs. 0.64). Coronary computed tomographic angiography provided significantly better prognostic information compared to FT and CAC testing (C-index: 0.72). Conclusion Among stable outpatients presenting with suspected CAD, most patients experiencing clinical events have measurable CAC at baseline while less than half have any abnormalities on FT. However, an abnormal FT was more specific for cardiovascular events, leading to overall similarly modest discriminatory abilities of both tests. Clinical Trial Registration URL: https://clinicaltrials.gov; Unique Identifier: NCT01174550

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“…A direct association between CAC and the incidence of chronic heart disease was observed in a large cohort of the asymptomatic population of men and women with a wide age range [178]. In symptomatic patients, combining assessment of traditional risk factors with CAC scoring supports a considerable sensitivity for prediction of significant coronary stenosis (over 50%) with higher specificity when assessed by CTCA [179]. Negative CTCA findings correlated with a low risk of MACE [180].…”

Section: Identifying Vulnerable Patientmentioning

confidence: 88%

Current Advances in the Diagnostic Imaging of Atherosclerosis: Insights into the Pathophysiology of Vulnerable Plaque

Mushenkova¹,

Summerhill

Zhang

et al. 2020

IJMS

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Atherosclerosis is a lipoprotein-driven inflammatory disorder leading to a plaque formation at specific sites of the arterial tree. After decades of slow progression, atherosclerotic plaque rupture and formation of thrombi are the major factors responsible for the development of acute coronary syndromes (ACSs). In this regard, the detection of high-risk (vulnerable) plaques is an ultimate goal in the management of atherosclerosis and cardiovascular diseases (CVDs). Vulnerable plaques have specific morphological features that make their detection possible, hence allowing for identification of high-risk patients and the tailoring of therapy. Plaque ruptures predominantly occur amongst lesions characterized as thin-cap fibroatheromas (TCFA). Plaques without a rupture, such as plaque erosions, are also thrombi-forming lesions on the most frequent pathological intimal thickening or fibroatheromas. Many attempts to comprehensively identify vulnerable plaque constituents with different invasive and non-invasive imaging technologies have been made. In this review, advantages and limitations of invasive and non-invasive imaging modalities currently available for the identification of plaque components and morphologic features associated with plaque vulnerability, as well as their clinical diagnostic and prognostic value, were discussed. Int. J. Mol. Sci. 2020, 21, 2992 2 of 26 by the low and oscillatory endothelial shear stress [3]. According to the current understanding, lesion development involves lipid accumulation in the arterial intima, resulting in foam cell formation, a local inflammatory response, and migration and proliferation of several cell types, including macrophages, smooth muscle cells (SMCs), lymphocytes, neutrophils, and dendritic cells that play a pivotal role in its progression. Lipid accumulation is a key event in the formation of the atherosclerotic lesion, and it is determined by different classes of lipoproteins [4]. Atherosclerotic plaque tends to develop early in life [5], progressing with age; however, the progression rate is not completely predictable and varies among individuals. In general, it undergoes a prolonged asymptomatic phase (lasting many years or several decades) until the manifestation of the first clinical symptoms often at the later stages of atherosclerosis. The mechanisms of plaque progression encompass SMC apoptosis, matrix synthesis, angiogenesis, arterial remodeling, fibrous cap rupture, and thrombosis, followed by necrosis and calcification. The most acute cardiovascular events are triggered by the rupture; erosion; or, the least common, calcified nodule, the vulnerable plaque phenotypes, followed by coronary thrombosis. Ruptured lesions are responsible for the majority (73%) of all ACSs [6]. In addition, the underlying mechanism of sudden coronary death from thrombi was found from plaque erosions, in 30%-35% of cases, and rarely from calcified nodules, in 2%-7% of cases [7].The biological features of two major classes of high-risk (vulnerable) plaques, such as rupture-pron...

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The coronary calcium score is a more accurate predictor of significant coronary stenosis than conventional risk factors in symptomatic patients: Euro-CCAD study

Cited by 44 publications

References 33 publications

Coronary Artery Calcium Score Improves the Prediction of Occult Coronary Artery Stenosis in Ischemic Stroke Patients

Coronary Artery Calcium Score Improves the Prediction of Occult Coronary Artery Stenosis in Ischemic Stroke Patients

Prognostic Value of Coronary Artery Calcium in the PROMISE Study (Prospective Multicenter Imaging Study for Evaluation of Chest Pain)

Current Advances in the Diagnostic Imaging of Atherosclerosis: Insights into the Pathophysiology of Vulnerable Plaque

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