Coronary Artery Calcium Score: Refining Risk stratification and Predicting Number Needed to Screen in Outpatients with Intermediate Risk Chest Pain

Document Type : Original Article

Authors

1 Department Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

2 Department Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Abstract

Objectives: Several studies have shown that coronary artery calcium scoring (CACs) is significantly
associated with the occurrence of major cardiovascular events. We aimed to look at the feasibility of
combining the Framingham risk Score (FRS) and CACs to refine risk stratification in outpatients with
intermediate risk chest pain and adding the value of using this combination to predict the number need
to screen (NNS) in those patients. Methods: We retrospectively reviewed 266 patients who underwent CCTA and CAC score and their FRS. The yield of screening for CAC was assessed by determining the NNS. Patients in this study were grouped based on FRS into very low risk (0-5), low risk
(5.1-10), intermediate risk (10.1-20) and high risk (> 20) groups. Results: The mean age of our patients was 51+10.56 years; 148 (55.76 %) were men. Of 266 study patients, 52.08% had a CACs of 0.
Patients with CACs >100 were significantly older and were men. Also, the prevalence of a positive
CACs for men was higher than that for women (P <0.013). Also, there was a significantly higher
CACs values with body mass index >27, smoking, diabetes mellitus and hypertension according to
Chi square nonparametric test. The CAC scores were significantly rising as the FRS increased. Using
CCTA, the number of CAD increased as the CAC score rose and the NNS decreased significantly as
the CAC score rose. Our study revealed that 93.1% of patients with zero CAC score had no significant CAD and only 6.9 % had significant CAD (i.e. ≥70% stenosis on CCTA). Conclusion: The
strategy of combining FRS and CAC is feasible in clinical practice to refine risk stratification in outpatients with intermediate risk chest pain. However, there is substantial heterogeneity between traditional risk and actual atherosclerosis burden. Also, our study can concluded that knowledge regarding
the NNS can lead to a more precise estimation of risk and may provide additional information of such
patients. NNS was much higher in participants with an FRS of 0 compared with those with an FRS
>10%

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