Coronary artery calcification – distribution, extent and 1-year outcomes in patients with low to intermediate pre-test probability of coronary artery disease.

• Main Authors: Han Bing, Chow, H. S., Ling, E. Z., Chan, B. K., Chung, L. K., Then, L. X., Pang, S. T., Chan, H. K., Khor, C. T., Tan, Y. Y., Oon, K. T., Koh, Y. L., Cham, Asri, Said, A. Y. Y., Fong, T. K., Ong
• Format: Article
• Language: English
• Published: Elsevier B.V. 2022
• Subjects: R Medicine (General)
• Online Access: http://ir.unimas.my/id/eprint/41002/3/Coronary.pdf; http://ir.unimas.my/id/eprint/41002/; https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0167527322015868?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0167527322015868%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww.internationaljournalofcardiology.com%2F

Background: Coronary artery calcium (CAC) is an established marker to predict major cardiovascular events (MACE), and has incremental value over traditional risk factors (CVRF). CAC is widely available, easily reproducible, and used in nearly all coronary computed tomography angiography (CCTA) assessment protocols for coronary artery disease (CAD). The distribution and extent of CAC, and its prognostic implications in local Malaysian patients with low to intermediate pre-test probability (LI-PTP) of CAD had not been established. Objectives: We aimed to establish the distribution, extent and prognostic implications of CAC in patients without known CAD, but with LI-PTP of CAD, undergoing CCTA for chest pain evaluation. Methods: Clinical information was obtained from consecutive patients who underwent CAC and CCTA examination from January 2020 to January 2021 at a single public access tertiary referral centre. The primary outcomes were the distribution and extent of CAC, and its relationship with MACE at 1 year. Results: Of 499 consecutive patients, 7 were excluded due to high PTP. CAC was present in 172/492 (35%). Within this group, 74/172 (41.3%) had CAC score of 1-100 (mild), 75/172 (42.4%) had a CAC of 101- 400 (moderate), 23/172 (13.4%) had CAC of >400 (high). 136 had suspected significant CAD and was offered conventional coronary angiography (CCA). 91/492 underwent CCA, and 38 were found to have significant CAD. Of those found to have significant CAD, 7/38 (18.4%) had CAC of zero, 8/38 (21.1%) had mild CAC, 12/38 (31.6%) moderate, and 11/38 (30%) high CAC. Severe CAC was associated with a higher rate of revascularization 11/23 (47.8%), compared to those with zero 7/320 (2.2%), mild 8/74 (10.8%) and moderate 12/75 (16%) CAC. Predictors of high CAC were age, male gender, and presence of cardiovascular disease risk factors. Of the 492 patients, 230 patients completed 1 year follow-up, and from this, 1 patient had a MACE. Conclusion In patients with LI-PTP risk of CAD, CAC was seen in approximately one third of our cohort. In the group with high CAC, a higher proportion required coronary revascularization, but MACE remained low at 1 year.