A study led by a team at the Charity University of Berlin in Germany has shown that CT coronary artery calcium scoring can identify which patients are at very low risk of heart attack or stroke. The findings may one day allow patients with stable chest pain but low risk scores to avoid invasive treatments such as coronary angiography.

This discovery was made today RadiologyJournal of the Radiological Society of North America

“Coronary artery calcium is a strong and independent predictor of cardiovascular events,” said Federico, first author of the study, MD candidate in the BIOQIC Research Training Group, and radiology resident in the Charité University Medical Residency. Mr. Biavati said. “The presence of coronary artery calcification indicates that atherosclerosis may have been present for some time.”

Coronary artery calcium scoring was first detailed in a study by Arthur Agatston and Warren Jannowitz in 1990 as a method to non-invasively measure the amount of calcium in the heart arteries. From this study, they developed the Agastson scale to quantify the level of calcification. A score of 1 to 399 on the scale indicates a moderate amount of plaque, and a score above 400 indicates a higher amount of plaque.

Furthermore, although the complete absence of coronary artery calcification is a strong indicator of the absence of advanced coronary atherosclerosis, in patients with stable chest pain, coronary artery calcium Its role in health is less clear. Stable chest pain is defined as a recurrent, temporary condition caused by stress, exercise, or cold.

To better understand the potential prognostic value of CT coronary artery calcium scores, researchers evaluated 1,749 patients aged 60 years and older for major coronary events. Patients were already enrolled in the DISCHARGE trial, which involves 26 centers in 16 European countries. This study was designed to examine which patients are suitable candidates for suspected coronary artery disease based on stable chest pain, cardiac computed tomography (CT), or cardiac catheterization. Based on the single-center experience of the CAD-Man study.

Patients in this new trial had stable chest pain and were referred for coronary angiography. Coronary angiography is an invasive procedure in which a catheter is inserted into the heart using x-rays as a guiding tool. A contrast agent is then injected through the catheter to help visualize the arteries of the heart. The team then stratified patients into three groups based on the Agatston score, denoting low-risk, intermediate-risk, and high-risk categories. The patient was then followed for her 3.5 years and major coronary events were recorded.

Patients with a coronary artery calcium score of zero were shown to have a very low risk of major cardiovascular events at follow-up. During the follow-up period, only 4 (0.5%) of the 755 participants in the group experienced a major adverse cardiovascular event. Additionally, the risk of obstructive coronary artery disease in this group was only 4.1%.

“This finding may indicate that a coronary calcium score of zero may play a greater role in patient management strategies,” said study leader and professor of radiology at Charité University. said Mark Dewey, MD, associate director. “The results of this study suggest that patients with stable chest pain and a coronary calcium score of zero may not require invasive coronary angiography using cardiac catheterization because their risk of cardiovascular events is so low. It suggests that there is a sex.”

In the score 1-399 group, 14 of 743 patients experienced a cardiac event, for a risk of 1.9%. Additionally, 17 cardiac events occurred among the 251 patients in the >400 coronary artery calcium score group, representing a significantly higher risk of 6.8%.

Although this study provides a strong signal that coronary artery calcium scores may inform future treatment decisions and help reduce unnecessary invasive angiography, the research team stated that further research is needed before the method can be translated into clinical care.