Value of Coronary Artery Calcium Scoring in Iranian Patients Suspected to Coronary Artery Disease.

UNLABELLED: Coronary artery calcium scoring (CACS) is a reasonable test for patients with the possibility of atherosclerosis. It can also be used for reclassifying the coronary artery disease (CAD) to the high-risk status by higher CACS and subsequently modifying the management of the patients.The purpose of this study was to investigate the association of CACS to the severity of coronary artery disease in the patients who were scheduled to perform coronary artery angiography (CAG) by tradition. CACS could be a simple, relatively cost-benefit, and noninvasive method for early screening of patients with obstructive coronary artery disease. METHOD: In the present study, CAC scoring was evaluated by non-enhanced Multi-Detector Computed Tomography (MDCT) in a total 239 patient suffering from coronary artery disease. Of them, 223 patients were planned to undergo CAG based on clinical examination or other noninvasive diagnostic methods (such as MPI, ETT, EKG or Echo). RESULTS: Our results showed that 11 of 67 patients with a negative CACS (zero) had obstructive coronary artery disease derived from the results of CAG. We also found a significant correlation between high CACS (more than 400) and extensive obstructive CAD, except for the two patients who had only mild CAD. There was a linear correlation between CACS and the severity of CAD on the basis of Gensini score and the number of involved arteries (CC=0.507, PV<0.001). Despite fairly high sensitivity (86.6) of zero CAC among patients with a negative score (86%), zero CACS cannot rule out the existence of obstructive coronary artery disease. As we found, increased level of CACS (>400) might be a significant indicative of CAD in referring patients.

Serum osteoprotegerin in relation to metabolic status, severity, and estimated risk of subsequent coronary heart disease.

BACKGROUND: Osteoprotegerin (OPG), a key factor in bone remodeling and vascular calcification, has been suggested to be associated with cardiovascular events. This study sought to assess the relationship between plasma OPG, anthropometric, metabolic status, severity and extent of coronary artery calcification, and the two-year recurrence risk of coronary event in patients with coronary heart disease (CHD). METHODS: A total of 155 consecutive patients with symptoms suggestive of CHD were enrolled in this cross-sectional study. Blood samples were taken for laboratory tests. Coronary angiography and cardiac CT scan were performed to assess the severity and extent of involved vessels. Two-year risk of subsequent CHD was estimated based on the computational Framingham risk prediction model. RESULTS: OPG level was in direct linear association with age (ß = 0.38, p < 0.001), waist to hip ratio (ß = 0.17, p < 0.05), hs-CRP (ß = 0.17, p < 0.05), systolic and diastolic blood pressure (ß = 0.17, p < 0.05; ß = 0.23, p < 0.01), and HbA1c (ß = 0.17, p < 0.05). After age-sex adjustment, only HbA1c (ß = 0.15, p < 0.05) was a significant indicator of serum OPG. OPG showed significant linear association with the coronary calcium score (CCS), and the number of involved vessels even after adjustment for age, sex, diabetes, blood pressure, and markers of bone-calcium metabolism (ß = 0.27, P < 0.05; ß = 29, P < 0.01). There is a significant positive association between two-year risk of subsequent CHD and serum OPG in females (ß = 0.45, P < 0.01) but not in males. CONCLUSION: Increased OPG is independently associated with the severity and extent of CHD. This study also proposes OPG as a potential marker in predicting the risk of subsequent CHD, in females.