Coronary Risk Stratification, Discrimination, and Reclassification Improvement Based on Quantification of Subclinical Coronary Atherosclerosis

Erbel, Raimund; Möhlenkamp, Stefan; Moebus, Susanne; Schmermund, Axel; Lehmann, Nils; Stang, Andreas; Dragano, Nico; Grönemeyer, Dietrich; Seibel, Rainer; Kälsch, Hagen; Bröcker-Preuß, Martina; Mann, Klaus; Siegrist, Johannes; Jöckel, Karl‐Heinz

doi:10.1016/j.jacc.2010.06.030

Cited by 666 publications

(262 citation statements)

References 40 publications

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“…Furthermore, CAC scoring is associated to a very low effective radiation dose (~1.0 mSv) and it has been extensively validated as an independent predictor of major adverse cardiac events and total mortality in asymptomatic patients, providing a significant incremental value over traditional risk factors and functional studies (30)(31)(32)(33).…”

Section: Mini-reviewmentioning

confidence: 99%

Progression of coronary artery calcification at the crossroads: sign of progression or stabilization of coronary atherosclerosis?

Rodríguez-Granillo

Carrascosa

Bruining

2016

Cardiovasc. Diagn. Ther.

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Coronary artery calcification (CAC) has been strongly established as an independent predictor of adverse events, with a significant incremental prognostic value over traditional risk stratification algorithms.CAC progression has been associated with a higher rate of events. In parallel, several randomized studies and meta-analysis have shown the effectiveness of statins to slow progression and even promote plaque regression. However, evidence regarding the effect of routine medical therapy on CAC has yielded conflicting results, with initial studies showing significant CAC regression, and contemporaneous data showing rather the opposite. Accordingly, there is currently a great controversy on whether progression of CAC is a sign of progression or stabilization of coronary artery disease (CAD). The finding of inexorable CAC progression despite the implementation of intensive contemporaneous medical therapy suggests that further understanding of this phenomenon should be undertaken before the implementation of CAC as a surrogate endpoint for longitudinal studies, or for prospective follow-up of patients under routine medical treatment.

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Section: Mini-reviewmentioning

confidence: 99%

Progression of coronary artery calcification at the crossroads: sign of progression or stabilization of coronary atherosclerosis?

Rodríguez-Granillo

Carrascosa

Bruining

2016

Cardiovasc. Diagn. Ther.

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“…CAC scoring is a predictor of cardiovascular events and may add incremental prognostic value to conventional cardiovascular risk factors [33,34]. The relative risk of coronary events increased with increasing CAC burden, and clinically useful thresholds (i.e.…”

Section: Discussionmentioning

confidence: 99%

Comparison of dual-source and electron-beam CT for the assessment of coronary artery calcium scoring

Reinsch

Aa²,

Lehmann³

et al. 2012

BJR

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Objective: Cardiac CT allows the detection and quantification of coronary artery calcification (CAC). Electron-beam CT (EBCT) has been widely replaced by high-end CT generations in the assessment of CAC. The aim of this study was to compare the CAC scores derived from an EBCT with those from a dual-source CT (DSCT). Methods: We retrospectively selected 92 patients (61 males; mean age, 60.7¡12 years) from our database, who underwent both EBCT and DSCT. CAC was assessed using the Agatston score by two independent readers (replicates: 1, 2; 35mean of reading 1 and 2). Results: EBCT scores were on average slightly higher than DSCT scores (281¡569 vs 241¡502; p,0.05). In regression analysis R Cardiac CT allows the detection and quantification of coronary artery calcification (CAC) and may thus add important in vivo information on the path from risk factor exposure to formation of clinical events [1][2][3][4]. Because of its advantages of being a fast technique with limited radiation exposure to the patients, various published clinical outcome data from CAC are based on electronbeam CT (EBCT), and therefore cut-points have been established for EBCT scans. However, since the appearance of newer generations of CT scanners such as dualsource CT (DSCT), scanners of this type are also widely used for CAC scoring as an alternative to EBCT. The spatial resolution of DSCT scanners is much higher, enabling the detection of smaller lesions, and DSCT is more applicable to other radiological procedures such as CT angiography [5]. CAC scoring is performed on these newer scanner generations using the Agatston score algorithm as the standard measure of CAC quantification. There is direct comparison of CAC scores between newer scanners and EBCT [6][7][8][9]. However, comparison between EBCT and DSCT is rare [10]. This is of interest for firsttime CAC scoring in asymptomatic subjects, and especially for evaluation of disease progression in subjects with prior EBCT testing. Therefore, the aim of this study was to evaluate the diagnostic accuracy of DSCT in the detection of CAC scores to EBCT. In addition, we compared techniques with each other, verifying the ability of CAC score classification. Methods and materials ParticipantsBetween September 2006 and February 2008 we selected participants from our database who had undergone DSCT coronary angiography for clinical evaluation of suspected coronary heart disease and who had recent EBCT scans for cardiovascular risk stratification. As part of the DSCT protocol, a prospectively gated non-contrast scan was performed. All patients were selected retrospectively. We did not collect any data prospectively. According to the clinical presentation, patients indicating a low pre-test likelihood of having a significant coronary artery stenosis were referred for coronary CT angiography instead of invasive coronary angiogram, just as those with a high pre-test likelihood of having

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“…In the intermediate risk group (10e20% 10-year Framingham risk) from the HeinzeNixdorf Recall Study, CAC led to significant reclassification above traditional risk estimation [12]. Greenland et al also found the greatest utility of CAC in reclassifying the intermediate Framingham 10-year risk group [13].…”

Section: Cac and Cardiovascular Riskmentioning

confidence: 99%

Coronary artery Calcium predicts Cardiovascular events in participants with a low lifetime risk of Cardiovascular disease: The Multi-Ethnic Study of Atherosclerosis (MESA)

Joshi

Patel

Blaha³

et al. 2016

Atherosclerosis

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Coronary Risk Stratification, Discrimination, and Reclassification Improvement Based on Quantification of Subclinical Coronary Atherosclerosis

Abstract: CAC scoring results in a high reclassification rate in the intermediate-risk cohort, demonstrating the benefit of imaging of subclinical coronary atherosclerosis. Our study supports its application, especially in carefully selected individuals with intermediate risk.

Cited by 666 publications

References 40 publications

Progression of coronary artery calcification at the crossroads: sign of progression or stabilization of coronary atherosclerosis?

Progression of coronary artery calcification at the crossroads: sign of progression or stabilization of coronary atherosclerosis?

Comparison of dual-source and electron-beam CT for the assessment of coronary artery calcium scoring

Coronary artery Calcium predicts Cardiovascular events in participants with a low lifetime risk of Cardiovascular disease: The Multi-Ethnic Study of Atherosclerosis (MESA)

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