Coronary artery calcium scoring with CT can identify symptomatic patients with a very low risk of heart attacks or strokes, according to a new study published in Radiology, a journal of the Radiological Society of North America (RSNA).
The findings may help patients with stable chest pain avoid invasive coronary angiography in the future.
CT calcium scoring noninvasively measures the amount of calcium in heart arteries. A score of 1 to 399 suggests moderate plaque, while 400 or higher indicates a large plaque burden. A score of zero is a strong indicator of low cardiovascular risk.
“Coronary artery calcium is a strong and independent predictor of cardiovascular events,” said study author Federico Biavati, M.D./Ph.D. candidate at Charité – Universitätsmedizin Berlin. “The presence of coronary artery calcification indicates long-standing atherosclerosis.”
Biavati and colleagues analyzed 1,749 patients with stable chest pain from the DISCHARGE trial, which included 26 centers in 16 European countries. Participants, average age 60, were referred for invasive coronary angiography. Patients were grouped by coronary calcium scores (0, 1–399, ≥400) and followed for 3.5 years.
Key findings include:
– 0.5% of participants with a score of 0 experienced major cardiovascular events (4 of 755).
– 1.9% event rate in those with a score of 1–399 (14 of 743).
– 6.8% event rate in participants with scores ≥400 (17 of 251).
“Patients with stable chest pain and a coronary calcium score of zero may not require invasive coronary angiography,” said Dr. Marc Dewey, professor and vice chair of radiology at Charité.
No significant differences in cardiovascular event risk were observed between sexes. Despite the promising results, more research is needed before coronary calcium scoring can fully replace coronary CT angiography.
This is the second article published from the DISCHARGE trial. A previous article showed body mass index did not affect outcomes between CT and invasive angiography for managing stable chest pain.
The study is published in Radiology.
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