Zero Calcium Score as a Filter for Further Testing in Patients Admitted to the Coronary Care Unit with Chest Pain

Relationship between Coronary Artery Calcium Score and Coronary Stenosis

Background

The coronary artery calcium score (CACS) is commonly employed to quantify the degree of calcification in coronary atherosclerosis. Indeed, increased coronary stenosis severity is associated with a progressive increase in CACS.

Objectives

This study sought to explore the association between CACS and coronary stenosis of ≥50% and ≥70%.

Methods

We conducted a retrospective analysis of patient data collected between July 1, 2017, and March 3, 2022, at Jiangmen Central Hospital. A total of 208 patients, presenting with both symptomatic and asymptomatic manifestations and suspected coronary artery disease (CAD), were included. Statistical analyses included ROC curve assessments, subgroup analyses based on age, and comparisons of CACS values against the presence of coronary stenosis ≥50% and ≥70%.

Results

Ultimately, 208 patients were included, with a median age of 65.0 years and a median CACS of 115.7 (interquartile range: 13.7-369.4). A CACS threshold of ≥1300 demonstrated a specificity of 100% for coronary stenosis of ≥50%. Notably, the percentage of patients with obstructive CAD showing CACS = 0 was significantly higher in those under 65 years (15.1%) compared to patients over 65 years (3.8%) (P=0.005). The inflection point, at which the risk probability for coronary stenosis of ≥50% shifted from being a protective factor to a risk factor, was observed when CACS fell within the range of 63.3 to 66.0.

Conclusion

CACS demonstrates good performance for the detection of coronary artery stenosis.

Assessing the Relationship Between American Heart Association Atherosclerotic Cardiovascular Disease Risk Score and Coronary Artery Imaging Findings

OBJECTIVE

The aim of this study was to characterize the relationship between computed tomography angiography imaging characteristics of coronary artery and atherosclerotic cardiovascular disease (ASCVD) score.

METHODS

We retrospectively identified all patients who underwent a coronary computed tomography angiography at our institution from December 2013 to July 2016, then we calculated the 10-year ASCVD score. We characterized the relationship between coronary artery imaging findings and ASCVD risk score.

RESULTS

One hundred fifty-one patients met our inclusion criteria. Patients with a 10-year ASCVD score of 7.5% or greater had significantly more arterial segments showing stenosis (46.4%, P = 0.008) and significantly higher maximal plaque thickness (1.25 vs 0.53, P = 0.001). However, among 56 patients with a 10-year ASCVD score of 7.5% or greater, 30 (53.6%) had no arterial stenosis. Furthermore, among the patients with a 10-year ASCVD score of less than 7.5%, 24 (25.3%) had some arterial stenosis.

CONCLUSIONS

There is some concordance but not a perfect overlap between 10-year ASCVD risk scores and coronary artery imaging findings.