Prognostic value of the coronary artery calcium score in suspected coronary artery disease: a study of 644 symptomatic patients.

AIM: The long-term value of coronary artery calcium (CAC) scanning has not been studied extensively in symptomatic patients, but was evaluated by us in 644 consecutive patients referred for stable chest pain. METHODS: We excluded patients with a history of cardiovascular disease and with a CAC score of zero. CAC scanning was done with a 16-row MDCT scanner. Endpoints were: (a) overall mortality, (b) mortality or non-fatal myocardial infarction and (c) the composite of mortality, myocardial infarction or coronary revascularisation. Revascularisations within 1 year following CAC scanning were not considered. RESULTS: The mean age of the 320 women and 324 men was 63 years. Follow-up was over 8 years. There were 58 mortalities, while 22 patients suffered non-fatal myocardial infarction and 24 underwent coronary revascularisation, providing 104 combined endpoints. Cumulative 8­year survival was 95% with CAC score <100, 90% in patients with CAC score >100 and <400, and 82% with CAC score ≥400 Agatston units. Risk of mortality with a CAC score >100 and ≥400 units was 2.6 [95% confidence interval (CI) 1.23-5.54], and 4.6 (95% CI 2.1-9.47) respectively. After correction for clinical risk factors, CAC score remained independently associated with increased risk of cardiac events. CONCLUSIONS: Risk increased with increasing CAC score. Patients with CAC >100 or ≥400 Agatston units were at increased risk of major adverse cardiac events and are eligible for preventive measures. CAC scanning provided incremental prognostic information to guide the choice of diagnostic and therapeutic options in many subjects evaluated for chest pain.

[Coronary calcium score using CT in the diagnosis of 2 patients with acute chest pain]. / Coronaire calciumscore met behulp van CT bij de diagnostiek van 2 patiënten met acute thoracale pijn.

A 38-year-old man presented with severe retrosternal pain that had persisted for several days. Physical examination, resting ECG and circulating levels of cardiac markers were normal. The patient had continuous pain during a bicycle test, but no signs of myocardial ischaemia were found. A CT scan was performed, and the resulting CT calcium score was 40 Agatston units (AU; > 90th percentile). Coronary angiography showed severe coronary artery disease. An arterial bypass operation took place. Recovery was uncomplicated and the patient remained free of symptoms. A 55-year-old man experienced midsternal pain that lasted 20 minutes before spontaneously subsiding. The ECG and troponine levels were normal. One week later, there were no abnormalities during a bicycle test and the CT calcium score was 0 AU. Therefore, there was no indication of coronary artery disease and a watchful waiting approach was taken. After 1 year of follow-up, the patient remained free of symptoms. For patients aged 45 years or more with acute chest pain and a CT calcium score of 0 AU, further cardiac evaluation is unnecessary. For patients aged less than 45 years, a CT calcium score greater than o is abnormal and requires additional cardiac evaluation.

Diagnostic and prognostic value of absence of coronary artery calcification in patients with stable chest symptoms.

UNLABELLED: The aim of this study was to determine the prognostic value of a coronary artery calcium score (CACS) of 0 in patients with stable chest symptoms and to compare it as a first-line test with bicycle exercise testing (X-ECG). Altogether, 315 consecutive patients over 44 years of age, with stable chest symptoms and no previous diagnosis of coronary artery disease (CAD) visited the outpatient clinic of our community hospital and underwent both CACS and X-ECG. The mean age was 60.54 years (SD 9.7; range 45-88 years). Of these patients, 141 had no detectable coronary calcium (44.8%) We excluded patients who did not sign informed consent (n = 4). Three patients were lost to follow-up. The follow-up group therefore consisted of 134 patients. The mean follow-up period was 44.6 months (25th-75th percentile: 35.5-54.3 months), during which no major adverse cardiac events (MACE) occurred. The negative predictive value (NPV) was 100%. X-ECG was negative in only 89 patients, equivocal in 39 patients and false-positive in 6 patients requiring additional stress myocardial imaging in 45 patients. NPV as a first-line test was therefore 66.4%. IN CONCLUSION: patients over 44 years with stable chest symptoms and no detectable coronary calcium have an excellent prognosis. CACS performs better compared with X-ECG as an initial test in patients with stable chest symptoms.