Coronary Artery Calcium Score: Refining Risk stratification and Predicting Number Needed to Screen in Outpatients with Intermediate Risk Chest Pain | ||||
| Minia Journal of Medical Research | ||||
| Article 42, Volume 30, Issue 4, October 2019, Page 266-276 PDF (509.02 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/mjmr.2019.221794 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
| Abeer M. Shawky1; Heba S. Abdelrahman2; Abdelmaksoud A. Elganady1 | ||||
| 1Department Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt | ||||
| 2Department 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% | ||||
| Keywords | ||||
| CAC score; coronary artery calcium; chest pain; cardiovascular risk screening | ||||
|
Supplementary Files
|
||||
|
Statistics Article View: 67 PDF Download: 66 |
||||
