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Low coronary calcium score in patients with obstructive coronary disease
Session:
Posters (Sessão 1 - Écran 1) - Imagem 1 - TC Cardíaca e Cardiologia Nuclear
Speaker:
Ana Filipa Abreu Cardoso
Congress:
CPC 2022
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.2 Computed Tomography
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Ana Filipa Cardoso; Paulo Pereira; Nuno Ferreira; Rita Faria; Wilson Ferreira; Mónica Carvalho; António Lourenço; Ricardo Fontes-Carvalho; Ricardo Ladeiras-Lopes
Abstract
<p><strong>Introduction: </strong>Coronary artery calcium score (CACS) is a marker of coronary atherosclerosis. However, a non-negligible number of patients has obstructive coronary artery disease (CAD) despite a low CACS. Our aim was to characterize patients with obstructive CAD on coronary computed tomography angiography (CCTA) and a low CACS.</p> <p><strong>Methods:</strong> Single-centre retrospective cohort study of patients with no known CAD who performed a CCTA from January 2017 to May 2021. Patients with obstructive CAD on CCTA (CAD-RADS classification of 4A/4B/5, therefore including at least a coronary stenosis of ≥70%) were included. A low CACS (calculated using the Agatston method) was considered if <100 AU.</p> <p>A combined endpoint (EP) of acute coronary syndrome (ACS), coronary revascularization by percutaneous coronary intervention (PCI) or surgery (CABG) and cardiovascular (CV) death was evaluated during the follow-up.</p> <p><strong>Results: </strong>From a total of 3436 exams, 298 (9%) patients were identified (73% male; mean age 60±9 years). Ninety-three (31%) had multivessel disease and median CACS was 170 (IQR 54-406) AU. Low CACS was present in 105 (35%) patients, including 16 with a CACS of 0.</p> <p>Patients with a low CACS and obstructive CAD were younger (57±11 vs 62±8 years, p<0.001) and had a lower prevalence of hypertension (58% vs 72%, p=0.015) and diabetes (15% vs 25%, p= 0.043). They had more frequently typical chest pain (34% vs 22%, p= 0.025) and less dyspnoea (4% vs 12%, p=0.020). Their pre-test probability of obstructive CAD (according to the new ESC model) was lower (13% IQR 10-24 vs 22% IQR 11-26, p=0.010). Multivessel disease on CCTA was less frequent (20% vs 38%, p=0.002).</p> <p>During a median follow-up of 29 (IQR 14-43) months, 126 (42%) patients had the combined EP (7 ACS; 92 PCI and 27 CABG). There were no CV deaths.</p> <p>There were no significant differences in the incidence of the combined EP, despite a trend towards a higher number of events in the low CACS group (hazard ratio=1.35, 95% CI 0.94-1.92; p=0.103). This was due to higher rates of PCI in the low CACS group (43% vs 27%; hazard ratio=1.73, 95% CI 1.16-2.58; p=0.007).</p> <p><strong>Conclusion: </strong>In our cohort, 35% of patients with obstructive CAD had a CACS lower than 100. Those patients were younger, had lower pre-test probability of CAD, but more typical presentation and higher rates of subsequent coronary revascularization by PCI. Our data adds value to the increasingly complex understanding of the association between CACS and presence of obstructive CAD.</p>
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