Detection silent coronary atherosclerosis

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Prognostic value of detection of silent coronary artery disease by computed tomographic scan

Dr Cèsar Morcillo MD, PhD

Internal Medicine

Hospital Cima

Barcelona, Spain

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Abrams J. N Engl J Med 2005;352:2524-2533


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The SCORE project.

Eur Heart J 2003;24:987


Add anything to make a coronary CT scan?


Coronary Calcium Score CT coronary angiography


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• Methods: – 243 patients without known atherosclerosis. – All patients were studied with coronary CT scan:

Coronary Calcium Score and CT coronary angiography. – Follow-up: 6.8 years. – Objective: to compare presented cardiovascular events

with estimated with REGICOR and SCORE functions.


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• Results: – 54% had coronary atherosclerosis.

47%54%


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• Results:


Variables demográficas Detección de Arterioesclerosis por TCDM Eventos

Toda la muestra (n=243) n (%)

No (n=113) n (%)

Sí (n=130) n (%)

pNo

(n=226) n (%)

Sí (n=17) n (%)

p

Edad media (DE) 55,4 50,2 (8.0) 60,0 (9,5) p<0,001 54,8 (9,8) 64,0 (10,9) p<0,001

Hombre 219 (90,1%) 102 (90,3%) 117 (90,0%) p=0,945 204 (90,3%) 15 (88,2%) p=0,787

Fumador o exfumador 157 (64,6%) 62 (54,9%) 95 (73,1%) p=0,003 147 (65,0%) 10 (58,8%) p=0,605

Sedentarismo 58 (23,9%) 27 (23,9%) 31 (23,8%) p=0,993 51 (22,6%) 7 (41,2%) p=0,083

Dislipemia 98 (40,3%) 33 (29,2%) 65 (50,0%) p=0,001 90 (39,8%) 8 (47,1%) p=0,558

Hipertensión 80 (32,9%) 23 (20,4%) 57 (43,8%) p<0,001 68 (30,1%) 12 (70,6%) p=0,001

Diabetes Mellitus 9 (3,7%) 3 (2,7%) 6 (4,6%) p=0,509 7 (3,1%) 2 (11,8%) p=0,124

Obesidad 38 (15,6%) 13 (11,5%) 25 (19,2%) p=0,098 34 (15,0%) 4 (23,5%) p=0,315

Hombre > 55 años 98 (40,3%) 23 (20,4%) 75 (57,7%) p<0,001 86 (38,1%) 12 (70,6%) p=0,008

Mujer > 65 años 7 (2,9%) 1 (0,9%) 6 (4,6%) p=0,126 6 (2,7%) 1 (5,9%) p=0,402Historia familiar de enfermedad coronaria

28 (11,5%) 7 (6,2%) 21 (16,2%) p=0,015 27 (11,9%) 1 (5,9%) p=0,701

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• Results:


Coronary Calcium Score

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!• CT coronary angiography predict cardiovascular

events and have incremental prognostic value beyond clinical risk scores.

• Detection of silent coronary atherosclerosis increases the risk of having an event 7,2 times more than those without atherosclerosis.

• This predictive power is greater than REGICOR (OR: 4,341) and SCORE (OR: 2,864).

• Results:


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• Results:


Detección de Arterioesclerosis por TCDM

Toda la muestra

(n=243) n (%)

No (n=113) n (%)

Sí (n=130)

n (%)p

Riesgo SCORE Bajo 109 (47,2%) 75 (68,2%) 34 (28,1%)

p<0,001 Intermedio 89 (38,5%) 31 (28,2%) 58 (47,9%) Alto 33 (14,3%) 4 (3,6%) 29 (24%)Riesgo REGICOR Bajo 127 (56,7%) 79 (73,1%) 48 (41,4%)

p<0,001 Intermedio 86 (38,4%) 25 (23,1%) 61 (52,6%) Alto 11 (4,9%) 4 (3,7%) 7 (6,0%)

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!• 54% patients had coronary atherosclerosis. • CT coronary angiography predicts cardiovascular events:

– More events at higher calcium score. – Detection of silent coronary atherosclerosis increases the risk of

having an event 7,2 times more than those without atherosclerosis. • CT coronary angiography has incremental prognostic value beyond

clinical risk scores. • 76% low-intermediate SCORE risk patients (94% with REGICOR)

already had atherosclerosis and should be reclassified to high risk.

• Conclusions:


Detection silent coronary atherosclerosis

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