TY - JOUR
T1 - Coronary Artery Calcium Score Predicts Major Adverse Cardiovascular Events in Stable Chest Pain
AU - Biavati, Federico
AU - Saba, Luca
AU - Boussoussou, Melinda
AU - Kofoed, Klaus F
AU - Benedek, Theodora
AU - Donnelly, Patrick
AU - Rodríguez-Palomares, José
AU - Erglis, Andrejs
AU - Štěchovský, Cyril
AU - Šakalytė, Gintarė
AU - Čemerlić Ađić, Nada
AU - Gutberlet, Matthias
AU - Dodd, Jonathan D
AU - Diez, Ignacio
AU - Davis, Gershan
AU - Zimmermann, Elke
AU - Kępka, Cezary
AU - Vidakovic, Radosav
AU - Francone, Marco
AU - Ilnicka-Suckiel, Małgorzata
AU - Plank, Fabian
AU - Knuuti, Juhani
AU - Faria, Rita
AU - Schröder, Stephen
AU - Berry, Colin
AU - Ruzsics, Balazs
AU - Rieckmann, Nina
AU - Kubiak, Christine
AU - Hansen, Kristian Schultz
AU - Müller-Nordhorn, Jacqueline
AU - Maurovich-Horvat, Pál
AU - Sigvardsen, Per E
AU - Benedek, Imre
AU - Orr, Clare
AU - Valente, Filipa Xavier
AU - Zvaigzne, Ligita
AU - Suchánek, Vojtěch
AU - Jankauskas, Antanas
AU - Ađić, Filip
AU - Woinke, Michael
AU - Cadogan, Diarmaid
AU - Lecumberri, Iñigo
AU - Thwaite, Erica
AU - Kruk, Mariusz
AU - Neskovic, Aleksandar N
AU - Mancone, Massimo
AU - Kuśmierz, Donata
AU - Kragelund, Charlotte
AU - Hove, Jens D
AU - Larsen, Linnea
AU - DISCHARGE Trial Group
PY - 2024/3
Y1 - 2024/3
N2 - Background Coronary artery calcium (CAC) has prognostic value for major adverse cardiovascular events (MACE) in asymptomatic individuals, whereas its role in symptomatic patients is less clear. Purpose To assess the prognostic value of CAC scoring for MACE in participants with stable chest pain initially referred for invasive coronary angiography (ICA). Materials and Methods This prespecified subgroup analysis from the Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) trial, conducted between October 2015 and April 2019 across 26 centers in 16 countries, focused on adult patients with stable chest pain referred for ICA. Participants were randomly assigned to undergo either ICA or coronary CT. CAC scores from noncontrast CT scans were categorized into low, intermediate, and high groups based on scores of 0, 1-399, and 400 or higher, respectively. The end point of the study was the occurrence of MACE (myocardial infarction, stroke, and cardiovascular death) over a median 3.5-year follow-up, analyzed using Cox proportional hazard regression tests. Results The study involved 1749 participants (mean age, 60 years ± 10 [SD]; 992 female). The prevalence of obstructive coronary artery disease (CAD) at CT angiography rose from 4.1% (95% CI: 2.8, 5.8) in the CAC score 0 group to 76.1% (95% CI: 70.3, 81.2) in the CAC score 400 or higher group. Revascularization rates increased from 1.7% to 46.2% across the same groups (P < .001). The CAC score 0 group had a lower MACE risk (0.5%; HR, 0.08 [95% CI: 0.02, 0.30]; P < .001), as did the 1-399 CAC score group (1.9%; HR, 0.27 [95% CI: 0.13, 0.59]; P = .001), compared with the 400 or higher CAC score group (6.8%). No significant difference in MACE between sexes was observed (P = .68). Conclusion In participants with stable chest pain initially referred for ICA, a CAC score of 0 showed very low risk of MACE, and higher CAC scores showed increasing risk of obstructive CAD, revascularization, and MACE at follow-up. Clinical trial registration no. NCT02400229 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Hanneman and Gulsin in this issue.
AB - Background Coronary artery calcium (CAC) has prognostic value for major adverse cardiovascular events (MACE) in asymptomatic individuals, whereas its role in symptomatic patients is less clear. Purpose To assess the prognostic value of CAC scoring for MACE in participants with stable chest pain initially referred for invasive coronary angiography (ICA). Materials and Methods This prespecified subgroup analysis from the Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) trial, conducted between October 2015 and April 2019 across 26 centers in 16 countries, focused on adult patients with stable chest pain referred for ICA. Participants were randomly assigned to undergo either ICA or coronary CT. CAC scores from noncontrast CT scans were categorized into low, intermediate, and high groups based on scores of 0, 1-399, and 400 or higher, respectively. The end point of the study was the occurrence of MACE (myocardial infarction, stroke, and cardiovascular death) over a median 3.5-year follow-up, analyzed using Cox proportional hazard regression tests. Results The study involved 1749 participants (mean age, 60 years ± 10 [SD]; 992 female). The prevalence of obstructive coronary artery disease (CAD) at CT angiography rose from 4.1% (95% CI: 2.8, 5.8) in the CAC score 0 group to 76.1% (95% CI: 70.3, 81.2) in the CAC score 400 or higher group. Revascularization rates increased from 1.7% to 46.2% across the same groups (P < .001). The CAC score 0 group had a lower MACE risk (0.5%; HR, 0.08 [95% CI: 0.02, 0.30]; P < .001), as did the 1-399 CAC score group (1.9%; HR, 0.27 [95% CI: 0.13, 0.59]; P = .001), compared with the 400 or higher CAC score group (6.8%). No significant difference in MACE between sexes was observed (P = .68). Conclusion In participants with stable chest pain initially referred for ICA, a CAC score of 0 showed very low risk of MACE, and higher CAC scores showed increasing risk of obstructive CAD, revascularization, and MACE at follow-up. Clinical trial registration no. NCT02400229 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Hanneman and Gulsin in this issue.
KW - Adult
KW - Humans
KW - Female
KW - Middle Aged
KW - Calcium
KW - Coronary Artery Disease/diagnostic imaging
KW - Chest Pain/diagnostic imaging
KW - Myocardial Infarction
UR - http://www.scopus.com/inward/record.url?scp=85188799904&partnerID=8YFLogxK
U2 - 10.1148/radiol.231557
DO - 10.1148/radiol.231557
M3 - Journal article
C2 - 38441097
SN - 0033-8419
VL - 310
JO - Radiology
JF - Radiology
IS - 3
M1 - e231557
ER -