Usefulness of Cardiac Computed Tomography in Coronary Risk Prediction: A Five-Year Follow-Up of the SPICA Study (Secure Prevention with Imaging of the Coronary Arteries)

Abstract

Accurate identification of individuals at high coronary risk would reduce acute coronary syndrome incidence and morbi-mortality. We analyzed the effect on coronary risk prediction of adding coronary artery calcification (CAC) and Segment Involvement Score (SIS) to cardiovascular risk factors. This was a prospective cohort study of asymptomatic patients recruited between 2013–2017. All participants underwent a coronary computed tomography angiography to determine CAC and SIS. The cohort was followed-up for a composite endpoint of myocardial infarction, coronary angiography and/or revascularization (median = five years). Discrimination and reclassification of the REGICOR function with CAC/SIS were examined with the Sommer’s D index and with the Net reclassification index (NRI). Nine of the 251 individuals included had an event. Of the included participants, 94 had a CAC = 0 and 85 a SIS = 0, none of them had an event. The addition of SIS or of SIS and CAC to the REGICOR risk function significantly increased the discrimination capacity from 0.74 to 0.89. Reclassification improved significantly when SIS or both scores were included. CAC and SIS were associated with five-year coronary event incidence, independently of cardiovascular risk factors. Discrimination and reclassification of the REGICOR risk function were significantly improved by both indexes, but SIS overrode the effect of CAC.

The Changing Complementary Role of Multimodality Imaging in Clinical Cardiology

“…The accurate identification of individuals at high coronary risk could help to reduce acute coronary syndrome incidence and morbimortality. Coronary risk prediction in clinical practice was improved through the addition of coronary artery calcification and segment involvement scores, assessed using computed tomography, for the obtainment of cardiovascular risk factors [ 2 ]. Coronary artery calcification and segment involvement scores were associated with a five-year coronary event incidence, independent of cardiovascular risk factors [ 2 ].…”

“…Coronary risk prediction in clinical practice was improved through the addition of coronary artery calcification and segment involvement scores, assessed using computed tomography, for the obtainment of cardiovascular risk factors [ 2 ]. Coronary artery calcification and segment involvement scores were associated with a five-year coronary event incidence, independent of cardiovascular risk factors [ 2 ]. In the research field, left ventricular myocardial and cavity Doppler velocity disturbances have been suggested to have the potential to become powerful predictors of significant coronary artery stenosis, as assessed using dobutamine stress Doppler echocardiography [ 3 ].…”

A self-report tool for identification of individuals with coronary atherosclerosis – The Swedish CArdioPulmonary BioImage Study

“…[1][2][3] A coronary artery calcification score (CACS) of ≥100, derived from computed tomography (CT) imaging, suggests benefits of statin therapy regardless of LDL concentrations in individuals with an intermediate IHD risk, according to the pooled cohort equation (PCE) risk calculator (7.5-20.0%). 1 Imaging with coronary CT angiography (CCTA) holds an even bigger promise, since it also visualizes non-calcified coronary atherosclerosis, degree of stenosis, and plaque characteristics; factors that are directly related to an increased risk of future clinical events [4][5][6][7][8] and that improve risk prediction beyond clinical risk scores such as the PCE. [8][9][10] However, the drawbacks of imaging include limited availability, high costs, and risks associated with radiation and use of contrast agents.…”

Self‐Report Tool for Identification of Individuals With Coronary Atherosclerosis: The Swedish CardioPulmonary BioImage Study

“… 1 , 2 , 3 A coronary artery calcification score (CACS) of ≥100, derived from computed tomography (CT) imaging, suggests benefits of statin therapy regardless of low‐density lipoprotein concentrations in individuals with an intermediate IHD risk, according to the pooled cohort equation (PCE) risk calculator (7.5%–20.0%). 1 Imaging with coronary CT angiography (CCTA) holds an even bigger promise, because it also visualizes noncalcified coronary atherosclerosis, degree of stenosis, and plaque characteristics, factors that are directly related to an increased risk of future clinical events 4 , 5 , 6 , 7 , 8 and that improve risk prediction beyond clinical risk scores such as the PCE. 8 , 9 , 10 However, the drawbacks of imaging include limited availability, high costs, and risks associated with radiation and use of contrast agents.…”