Incremental prognostic value of multi-slice computed tomography coronary angiography over coronary artery calcium scoring in patients with suspected coronary artery disease

Abstract

MSCTA provides additional information to CS regarding stenosis severity and plaque composition. This additional information was shown to translate into incremental prognostic value over CS.

High Calcium Score Predicts Severity of the Culprit Lesions in Patients with Acute Coronary Syndromes

“…Similar to other studies published in the literature [6], our results show that the diff erence between culprit lesion's plaque volume in patient with calcium score above 1000 and patients with calcium score below 1000 were statistical signifi cant (p = 0.0002). In case of a cut-off point of calcium score of 600 or even 400, the diff erences between the groups remained statistically signifi cant, even if less expressed.…”

“…Th is fi nding helps the clinician in early detection/prevention in asymptomatic patients with low to intermediate risk score (Recommendations for Calcium Scoring Methods Class IIA, IIB: 2010 ACCF/ AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults: Executive Summary) [7] and in diagnosis of coronary artery disease in symptomatic patients with low and intermediate risk [6,8]. Using this information and assessing our result we had a tendency to manage the intermediate or high risk patients with high calcium score to emergency catheterization laboratory to invasive treatment knowing that this categories of patients is more vulnerable than patients with low calcium score, with less vulnerable lesion.…”

“…Some investigators believe that calcium stabilizes the plaque, this information is based on some results that showed that in stable angina the calcium score is higher than in acute coronary syndrome [6,10]. It was suggested that CAD patients with high calcium score have more vulnerable plaque components [8,11] (such as higher burden with calcium or presence and extent of the necrotic core within the plaques) than those with low calcium score [4,10,12].Our study results showed that patients with acute coronary syndrome and high calcium score had low attenuation voluminous plaque.…”

Predictive Value of Adiponectin in Patients with Multivessel Coronary Atherosclerosis Detected on Computed Tomography Angiography

“…Therefore, CTCA is more effective at detecting early-stage CAD than functional imaging techniques that assess myocardial perfusion and wall motion 10) . Identifying coronary plaques using CTCA has prognostic value; several studies have demonstrated that the extent of coronary plaques, as determined on CTCA, can predict all-cause mortality and the occurrence of major adverse cardiac events, including cardiac death, myocardial infarction and unstable angina pectoris requiring coronary revascularization [11][12][13][14][15][16] . These findings suggest that conducting risk assessments using CTCA are beneficial for improving the selection of patients who receive aggressive OMT, although it is important to carefully weigh the risk of contrast-induced nephropathy and radiation exposure.…”

“…Abbreviations: LDL, low-density lipoprotein; ACE-Is, angiotensinconverting enzyme inhibitors; ARBs, angiotensin Ⅱ receptor blockers; CTCA, computed tomography coronary angiography; CACS, coronary artery calcification score. cardiovascular events [11][12][13][14][15][16] . These studies suggest that with suitable selection of patients, CTCA can be used to identify multiple coronary plaques before the development of fatal CAD, thus enabling the use of aggressive OMT and reducing the incidence of cardiovascular events.…”