Prognostic value of coronary artery calcium score in patients with symptoms suggestive of coronary artery disease. Results from the Silesian Calcium Score (SILICAS) study.

INTRODUCTION    The prognostic value of coronary artery calcium score (CACS) in symptomatic patients with a suspicion of coronary artery disease (CAD) has been poorly defined. OBJECTIVES    The aim of the study was to assess the predictive value of the CACS in the incidence of major adverse coronary events (MACEs) in patients with an intermediate probability of CAD and establish its usefulness as the first-line risk assessment tool. PATIENTS AND METHODS    This single-center, observational, prospective study enrolled consecutive symptomatic patients without a previous diagnosis of CAD, referred to our center for CACS assessment with non-contrast-enhanced cardiac computed tomography (CT). CACS measurements were performed using an electrocardiogram-gated 64-row CT scanner. The CACS measurement was treated as the first­line noninvasive test. Patients with positive CACS values were divided into 4 subgroups: <100 Agatston units (AU), 100 to 399 AU; 400 to 999 AU; and ≥1000 AU. The incidence of MACEs was analyzed in 2 ways: negative versus positive CACS and by the CACS subgroups. RESULTS    We included 588 patients (mean age, 61.1 ±9.7 years; women, 64%). The median follow-up period was 707 days. There were 239 patients (49.3%) with no coronary calcium. In these patients, no MACEs were observed, while in those with positive CACS values, they occurred in 108 patients (30.9%) (P <0.001). The incidence of MACEs was dependent on the CACS values, reaching 91% in those with a CACS of 1000 or higher AU. CONCLUSIONS    In selected symptomatic patients with an intermediate probability of CAD, the CACS measurement may be used as the first-line test to assess the risk of MACEs.

Coronary artery calcium in type 2 diabetes: a nested case­control study.

INTRODUCTION: The use of classic risk scores in patients with type 2 diabetes have numerous limitations. Relationships between coronary artery calcium score (CACS) and traditional risk factors are derived from statistical analyses. At present, there are no data on the evaluation of the CACS on 64­slice multi-detector computed tomography in patients with type 2 diabetes and ischemic symptoms based on a head­to­head comparison with matched nondiabetics. OBJECTIVES: We aimed to examine the associations between traditional risk factors and the CACS in a nested case­control study. PATIENTS AND METHODS: We performed a retrospective analysis of data from 2482 consecutive symptomatic subjects with known CACS. We identified 325 patients with type 2 diabetes. From the remaining subjects, 325 controls matched for age, sex, and risk factors were selected. RESULTS:  Higher CACS values were observed in patients with diabetes (median, 50 Agatston units [AU]; range, 0-4330) compared with nondiabetic controls (9 AU, 0-3036, P <0.001). Positive CACS values were more common in diabetic patients (73.5%) compared with nondiabetic controls (60.9%, P <0.001). The highest CACS value was observed in men (95.5 AU, 0-3755). The median CACS value in nondiabetic men was comparable to those in diabetic women (24.5 AU, 0-3036 vs. 24.5 AU, 0-3755). The lowest CACS values were observed in control women (3 AU, 0-2144). Coronary artery calcium was more diffused in diabetic patients compared with controls (P <0.01). A multivariate analysis showed that older age and male sex were independent predictors of the CACS. Traditional risk factors accounted only for 10% of interindividual variance in the presence of calcified atherosclerotic plaques. CONCLUSIONS: Coronary calcified lesions are more frequent in symptomatic patients with type 2 diabetes compared with matched nondiabetic subjects. Our results seem to provide evidence that traditional risk factors do not explain more common, diffuse, and extensive calcified lesions in diabetic subjects.

The presence of endocardial leads may limit applicability of coronary CT angiography.

OBJECTIVES: Some indications that MSCT is necessary may be visible in patients with implanted pacemakers, CRTs and ICDs devices. Purpose. To evaluate whether the presence of endocardial leads influences the quality of visualization of the coronary arteries in MSCT. DESIGN: In 37 patients a 64-slice MSCT (Aquilion 64, Toshiba) was performed due to a suspicion of ischemic heart disease (33 patients) or suspicion of lead perforation (four patients). The control group consists of 35 patients. Influence of the leads was evaluated independently by two cardiologists. RESULTS: The total number of leads that were evaluated was 63. In 26 cases (41%) significant problems with the evaluation of coronary arteries occurred: LM-1 (2%) case, LAD-3 (5%) cases, LCx-4 (6%) cases, RCA-18 (28%) cases. The presence of a right ventricular lead did not influence the quality of the imaging of the left main coronary artery (LM) and its main branches (LAD and LCx). The main concerns were related to the RCA visualization-interpretable images in 18/63 (29%) of the analyzed leads. CONCLUSIONS: The presence of implanted endocardial leads may limit the applicability of coronary CT angiography in patients with implanted anti-arrhythmic devices.