Home Medizin Die Kalziumbewertung der Koronararterien mittels CT kann das Risiko von Herzinfarkten oder Schlaganfällen vorhersagen

Die Kalziumbewertung der Koronararterien mittels CT kann das Risiko von Herzinfarkten oder Schlaganfällen vorhersagen

von NFI Redaktion

According to a new study published today in Radiology, a journal of the Radiological Society of North America (RSNA), symptomatic patients with a very low risk of heart attacks or strokes can be identified using CT analysis of coronary artery calcium. The researchers said the results could one day help some patients with stable chest pain avoid invasive coronary angiography.

Coronary artery calcium scoring with CT was developed to non-invasively measure the amount of calcium in the arteries of the heart. Higher scores are associated with arteriosclerosis, a buildup of plaque in the arteries. For example, a score of 1 to 399 indicates a moderate amount of plaque, while a score of 400 or higher indicates a significant plaque burden.

Coronary artery calcium is a strong and independent predictor of cardiovascular events. The presence of coronary artery calcification indicates that arteriosclerosis may have been present for some time.


Federico Biavati, lead author of the study, MD/Ph.D. candidate in the BIOQIC graduate program and radiology assistant at Charité – Universitätsmedizin Berlin, Germany

On the other hand, the complete absence of coronary calcification is a good indicator of the absence of advanced arteriosclerosis. However, the role of coronary artery calcium in patients with stable chest pain is less clear. Stable chest pain is a temporary but recurring condition triggered by stress, physical activity, or cold weather.

Under the leadership of Marc Dewey, MD, Professor and Deputy Chair of Radiology at Charité, Biavati and colleagues assessed the prognostic value of coronary artery calcium assessment for serious adverse cardiovascular events in 1,749 individuals with an average age of 60 years. The participants were from the DISCHARGE Trial, a research project involving 26 centers in 16 European countries. The participants had persistent chest pain and were referred for invasive coronary angiography, a procedure in which a catheter is inserted into the heart under X-ray guidance. Contrast dye is then injected through the catheter to help doctors visualize the heart arteries.

The researchers categorized the patients based on their coronary artery calcium scores into low, medium, and high-risk categories. They observed the participants for an average of 3.5 years and recorded all serious adverse cardiovascular events.

Individuals with a coronary artery calcium score of zero showed a very low risk of serious adverse cardiovascular events at follow-up. Only four out of the 755 participants in the group, or 0.5%, experienced a serious adverse cardiovascular event during the follow-up period. The group also had a low risk of only 4.1% for obstructive coronary heart disease.

This finding could suggest that a zero calcium score in the coronary artery may play a greater role in patient management strategies,“ said Dr. Dewey. „The results suggest that patients with stable chest pain and a coronary artery calcium score of zero may not need invasive coronary angiography via cardiac catheterization, as the risk of cardiovascular events is so low.“

Among the 743 participants, there were 14 events with a coronary artery calcium score of 1 to 399, equating to a 1.9% risk. The 251 participants in the group with a coronary artery calcium score of 400 and higher had 17 events with a significantly higher risk of 6.8%. The researchers found no evidence of a difference between genders in serious adverse cardiovascular events.

Despite the results, the researchers stated that further studies are needed before patients can be excluded from coronary CT angiography based on coronary artery calcium assessment.

This is the second article published in Radiology from the DISCHARGE study, the largest study on chest pain. The first article, Influence of Body Mass Index on the Efficacy of CT Compared to Invasive Coronary Angiography in Stable Chest Pain: The DISCHARGE Study, found that there were no differences in clinical outcomes between patients initially undergoing CT treatment and those undergoing invasive coronary angiography when stratifying patients suspected of coronary heart disease by body mass index category.

Source:

Radiological Society of North America

Journal Reference:

Biavati, F., et al. (2024) Coronary Artery Calcium Score Predicts Serious Adverse Cardiovascular Events in Stable Chest Pain. Radiology. doi.org/10.1148/radiol.231557.

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