Mallory S Lo-Kioeng-Shioe1, Dorine Rijlaarsdam-Hermsen2, Ron T van Domburg1, Martin Hadamitzky3, João A C Lima4, Sanne E Hoeks1, Jaap W Deckers5. 1. Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. 2. Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Medical Center Haaglanden Bronovo, The Hague, the Netherlands. 3. Institut für Radiologie und Nuklearmedizin, Hospital at the Technische Universität München, Munich, Germany. 4. Department of Cardiology, Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA. 5. Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. Electronic address: j.deckers@erasmusmc.nl.
Abstract
BACKGROUND: Coronary artery calcium (CAC) scanning has evolved into an important subclinical prediction method for cardiovascular diseases in asymptomatic subjects. However, the prognostic implication of CAC scanning in symptomatic individuals is less clear. OBJECTIVES: To assess the prognostic utility of CAC in predicting risk of major adverse cardiac events (MACE) in stable patients with suspected CAD. METHODS: We did a systematic electronic literature search for studies presenting original data in CAC score, and reporting cardiovascular events in stable, symptomatic patients as primary outcome. Primary outcome of the meta-analysis was the occurrence of MACE, a composite of late coronary revascularization, hospitalization for unstable angina or heart failure, nonfatal myocardial infarction, and cardiac death or all-cause mortality. Using random effects models, we pooled relative risk ratios of CAC for MACE, and adjusted hazard ratios (HR) of the associations between different CAC strata (CAC 0-100,100-400, and ≥ 400, versus CAC = 0) and incident MACE. RESULTS: We included 19 observational studies (n = 34,041). In total, 1601 events were analyzed, of which 158 in patients with CAC = 0. The pooled relative risk ratio was 5.71 (95%-CI: 3.98;8.19) for subjects with CAC > 0. The pooled estimate of adjusted HRs demonstrated increasing, positive associations, with the strongest association for CAC > 400 (HR: 4.88; 95%-CI: 2.44;9.27). CONCLUSIONS: This meta-analysis demonstrated that increased levels of CAC are strongly and independently associated with increased risk for MACE in stable, symptomatic patients with suspected CAD, showing increasing risk with greater CAC scores. Application of CAC scanning as a prediction method could be useful for a considerable number of such patients.
BACKGROUND: Coronary artery calcium (CAC) scanning has evolved into an important subclinical prediction method for cardiovascular diseases in asymptomatic subjects. However, the prognostic implication of CAC scanning in symptomatic individuals is less clear. OBJECTIVES: To assess the prognostic utility of CAC in predicting risk of major adverse cardiac events (MACE) in stable patients with suspected CAD. METHODS: We did a systematic electronic literature search for studies presenting original data in CAC score, and reporting cardiovascular events in stable, symptomatic patients as primary outcome. Primary outcome of the meta-analysis was the occurrence of MACE, a composite of late coronary revascularization, hospitalization for unstable angina or heart failure, nonfatal myocardial infarction, and cardiac death or all-cause mortality. Using random effects models, we pooled relative risk ratios of CAC for MACE, and adjusted hazard ratios (HR) of the associations between different CAC strata (CAC 0-100,100-400, and ≥ 400, versus CAC = 0) and incident MACE. RESULTS: We included 19 observational studies (n = 34,041). In total, 1601 events were analyzed, of which 158 in patients with CAC = 0. The pooled relative risk ratio was 5.71 (95%-CI: 3.98;8.19) for subjects with CAC > 0. The pooled estimate of adjusted HRs demonstrated increasing, positive associations, with the strongest association for CAC > 400 (HR: 4.88; 95%-CI: 2.44;9.27). CONCLUSIONS: This meta-analysis demonstrated that increased levels of CAC are strongly and independently associated with increased risk for MACE in stable, symptomatic patients with suspected CAD, showing increasing risk with greater CAC scores. Application of CAC scanning as a prediction method could be useful for a considerable number of such patients.
Authors: Ramachandran S Vasan; Stephanie Pan; Martin G Larson; Gary F Mitchell; Vanessa Xanthakis Journal: Hypertension Date: 2021-10-04 Impact factor: 10.190
Authors: Moniek Y Koopman; Robert T A Willemsen; Pim van der Harst; Rykel van Bruggen; Jan Willem C Gratama; Richard Braam; Peter M A van Ooijen; Carine J M Doggen; Geert-Jan Dinant; Bas Kietselaer; Rozemarijn Vliegenthart Journal: Rofo Date: 2022-01-26
Authors: Moniek Y Koopman; Jorn J W Reijnders; Robert T A Willemsen; Rykel van Bruggen; Carine J M Doggen; Bas Kietselaer; Martijn J Oude Wolcherink; Peter M A van Ooijen; Jan Willem C Gratama; Richard Braam; Matthijs Oudkerk; Pim van der Harst; Geert-Jan Dinant; Rozemarijn Vliegenthart Journal: BMJ Open Date: 2022-04-19 Impact factor: 3.006