Abstract
ObjectivesTo evaluate diagnostic yield of coronary artery calcium (CAC) scoring using multidetector CT imaging in rheumatoid arthritis (RA) patients presented with chest pain. Patients and methodsSeventy RA patients evaluated using the 28 joint disease activity (DAS-28) score, Disability Index (DI) and radiologically for Larsen–Dale index. Patients underwent assessment for coronary artery disease (CAD) risk factors and coronary risk stratification using the Framingham Risk Score (FRS). Patients were clinically categorized according to criteria for typical anginal pain (TAP) and were scanned using a 64-row spiral CT scanner for CAC scoring and were stratified according Agatston CAC scores for calculation of total Agatston score (TAS). ResultsClinically, 32 patients had full criteria of TAP, 27 patients showed a picture of atypical anginal pain, while 11 patients had non-anginal chest pain. FRS predicted low, intermediate and high risk of CAD in 34, 18 and 18 patients, respectively. TAS defined no CAC in 4 patients, while mild, moderate and severe CAC was detected in 24, 36 and 6 patients, respectively. Regression analysis defined low HDL blood level, current smoking and high TAS, DAS-28 and FRS as significant predictor for TAP in decreasing order of significance. Receiver operating characteristic (ROC) curve analysis defined low HDL blood level and high TAS as the significant sensitive and specific tests, respectively. There was positive significant correlation between FRS and both of TAS scores and extent of coronary stenosis. However, FRS was the least significant predictor for TAP. ConclusionScreening of RA patients with combination of clinical scoring using FRS and CAC using non-invasive multidetector CT could allow early detection of patients at risk for acute cardiovascular events. However, TAS acts better for the prediction of TAP.
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