CT coronary artery calcium scoring was developed to non-invasively measure the amount of calcium in the arteries of the heart. Higher scores are associated with atherosclerosis, a buildup of plaque within the arteries. For example, a score of 1 to 399 suggests a moderate amount of plaque, and 400 or higher indicates a heavy plaque burden.

“Coronary artery calcium is a strong and independent predictor of cardiovascular events,” said Federico Biavati, MD/PhD, lead author of the study. He is a candidate in the BIOQIC research training group and a radiology resident at the Charité University of Berlin, Germany. “The presence of coronary artery calcification indicates that atherosclerosis may have been present for some time.”

On the other hand, the complete absence of coronary artery calcification is a good indicator of the absence of advanced atherosclerosis. However, the role of coronary calcium in patients with stable chest pain is less clear. Stable chest pain is a temporary but recurring symptom caused by stress, exercise, or cold.

Under the direction of Mark Dewey, M.D., professor and associate director of radiology at Charité University, Biavati et al. studied the prognostic value of coronary artery calcium scores for major adverse cardiovascular events in 1,749 people with an average age of 60 years. was evaluated. Participants were selected from hospital discharges. The trial is a research project involving 26 centers in 16 European countries. The participant had stable chest pain and was recommended to undergo an invasive coronary angiogram, which involves inserting a catheter into the heart under X-ray guidance. A contrast dye is then injected through the catheter to help the doctor visualize the heart arteries.

Researchers stratified patients into low-risk, intermediate-risk, and high-risk categories based on coronary artery calcium scores. They followed participants for an average of 3.5 years and recorded major adverse cardiovascular events.

People with a coronary artery calcium score of zero were shown to have a very low risk of major cardiovascular events during follow-up. Only 4 of 755 participants (0.5%) in the group had a major adverse cardiovascular event during follow-up. This group also had a lower risk of obstructive coronary artery disease, at only 4.1%.

“This finding may indicate that a coronary calcium score of zero may play a larger role in patient management strategies,” Dr. Dewey said. “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.”

Among 743 participants, there were 14 events with coronary calcium scores between 1 and 399, representing a risk of 1.9%. There were 17 events among the 251 participants in the group with a coronary calcium score of 400 or higher, with a significantly higher risk of 6.8%. The researchers found no evidence of differences between men and women in major adverse cardiovascular events.

Despite these findings, the researchers said further research is needed before coronary calcium scores can be used to exclude patients from coronary CT angiography.

This is the second article published in Radiology Results from the DISCHARGE trial, the largest cardiac trial for chest pain. first article, Effect of BMI on the effectiveness of CT versus invasive coronary angiography in stable chest pain: the DISCHARGE study, When we stratified patients with suspected coronary artery disease by BMI category, we found that no difference in clinical outcomes was observed between patients who underwent initial management with CT and those who underwent invasive coronary angiography.