Prediction of cardiac events based on coronary calcium score in patients with symptoms suggestive of coronary artery disease

Abstract

Objective: To determine predictive value of coronary artery calcium score (CACS) for major adverse cardiovascular events (MACE) in symptomatic patients with atypical chest pain and suspected coronary artery disease (CAD) using a 64-row multislice computed tomography (MSCT). Background: In asymptomatic patients, positive CACS is an established marker of coronary plaque burden and it is associated with higher risk of MACE. Zero CACS has been associated with low risk of MACE. In symptomatic patients without previous diagnosis of CAD, prognostic significance of CACS is less well established. Methods: 588 consecutive symptomatic subjects (376 women, 212 men; age 61±10 years) with atypical chest pain were included in the study. CACS was determined in each subject using 64-row MSCT. CT angiography was not performed to avoid treatment bias. Patients were observed for occurrence of combined MACE (death, myocardial infarction, myocardial revascularization). Results: For all patients median CACS was 11 Agatston Units (AU; range 0 to 5927). Zero CACS was present in 239 patients while CS>0 was present in 349 patients. During the follow-up of 638±261 days MACE occured only in patients with a positive CACS (P<0.0001; logrank). Absence of coronary calcium defined a low risk group of patients (HR=0.17, CI 0.03-0.39; Figure 1). CS<92 AU was the optimal cut-off point for definition of the low risk group (ROC; P<0.001, sensitivity 90.1, specificity 82.6; AUC 0.93). Figure 1.MACE free survival in CS groups Conclusions: CACS assessment may be a useful tool for risk stratification in symptomatic patients with atypical chest pain. Absence of coronary calcium defines a low risk group in these subjects. Larger multicentre observational studies are warranted to determine prognostic CACS