The 2025 ESC/EAS Dyslipidaemia Focused Update: Clinical Interpretation and Practical Implications.

Background:Coronary artery calcification which is determined quantitatively by coronary calcium scoring has been known as a sign of coronary stenosis and thus future cardiac events; hence it has been noticed on spotlight of researchers in recent years. Developing different method for early and optimal detection of coronary artery disease (CAD) is really essential as CAD are the first cause of death in population.Objectives:To evaluate predictive value of vessel specific coronary artery calcium (CAC) score in predicting obstructive coronary artery disease.Patients and Methods:In this diagnostic test study we evaluated patients with coronary computed tomography angiography (CCTA) and CAC score which had been referred to two referral radiology center in Tehran, Iran and finally we selected 2525 patients in a single and sequential pattern to create a diagnostic study. The whole-heart CAC scores and vessel specific CAC scores were calculated individually for the 4 major epicardial coronary arteries in 2 distinct group; group A ( patients with previous history of CABG) and group B (patients without history of CABG). For evaluation of obstruction tree cut off points were described: 0 > ; at least 1 segment with any kind of stenosis, ≥ 50; at least 1 segment with stenosis ≥ 50, ≥ 70; at least 1 segment with stenosis ≥ 70.Results:Mean of coronary calcium scores in terms of each coronary artery vessel increase by increasing coronary stenosis grade in group B; LAD, RCA, LCX respectively have mean CAC score 6.06, 6.21 and 5.04 in normal patients and 221.6, 226.7 and 106.6 in patients with complete stenosis. As expected these findings don't work for group A. Also By increasing calcium score cutoff in all four vessels sensitivity decreased and specificity increased but steal LAD had higher sensitivity than other vessels and LM had higher specificity. Thus using calcium score method is useful for ruling out stenosis in LAD while calcium score of LM can predict existence of stenosis in LM. However none of the vessel specific CAC can reach to 100% sensitivity and specificity of CCTA method.Conclusions:CCTA is highly superior than vessel specific CAC score thus to minimize patients radiation does maybe we can eliminate CAC scan as a routinely perform procedure at the beginning of the CCTA.

Coronary Artery Calcium Scoring for Risk Assessment in Patients With Severe Hypercholesterolemia

Background. We evaluated the value of coronary artery calcification (CAC) score in coronary artery disease (CAD) detection in asymptomatic hemodialysis (HD) patients by evaluating the association among CAC score, exercise electrocardiography (EECG), and Thallium-201 dipyridamole scintigraphy. Correlation between aortic pulse wave velocity (PWV) and CAC score was also evaluated. Methods. CAC score was assessed with conventional computed tomography in 40 patients. Thirty patients completed EECG and 25; those with a positive CAC score and/or a positive EECG performed Thallium dipyridamole scintigraphy. Carotid-femoral PWV was assessed in all patients. Results. There was no association among CAC score and EECG or Thallium dipyridamole scintigraphy. In contrast, CAC score was correlated with aortic PWV. Conclusion. The previous results question the role of CAC score in the detection of CAD in asymptomatic HD patients. The correlation between CAC score and aortic PWV raises the possibility that CAC score represents more an indicator of coronary artery medial wall calcification than a marker of CAD.

PET/CT imaging of myocardial blood flow and arterial calcium: Putting the pieces together

BACKGROUND. Coronary artery calcium (CAC) scoring is used to stratify acute coronary syndrome (ACS) risk. Nonetheless, patients with a CAC score of zero (CAC0) remain at risk from noncalcified plaque components. OBJECTIVE. The purpose of this study was to explore CTA-derived coronary artery plaque characteristics in symptomatic patients with CAC0 who subsequently have ACS through comparisons with patients with a CAC score greater than 0 (CAC> 0) who subsequently have ACS as well as with patients with CAC0 who do not subsequently have ACS. METHODS. This study entailed a secondary retrospective analysis of prior prospective registry data. The international multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry collected longitudinal observational data on symptomatic patients who underwent clinically indicated coronary CTA from January 2004 to May 2010. ICONIC (Incident Coronary Syndromes Identified by CT) was a nested cohort study conducted within CONFIRM that identified patients without known coronary artery disease (CAD) at the time of CTA who did and did not subsequently have ACS (i.e., the ACS and control groups, respectively) and who were propensity matched in a 1:1 ratio on the basis of CAD risk factors and CAD severity on CTA. The present ICONIC substudy selected matched patients in the ACS and control groups who both had documented CAC scores. CTA examinations were analyzed using artificial intelligence software for automated quantitative plaque assessment. In the ACS group, invasive angiography findings were used to identify culprit lesions. RESULTS. The present study included 216 patients (mean age, 55.6 years; 91 women and 125 men), with 108 patients in each of the ACS and control groups. In the ACS group, 23% (n = 25) of patients had CAC0. In the ACS group, culprit lesions in the subsets of patients with CAC0 and CAC> 0 showed no significant differences in fibrous, fibrofatty, or necrotic-core plaque volumes (p > .05). In the CAC0 subset, patients with ACS, compared with control patients, had greater mean (± SD) fibrous plaque volume (29.4 ± 42.0 vs 5.5 ± 15.2 mm3, p < .001), fibrofatty plaque volume (27.3 ± 52.2 vs 1.3 ± 3.7 mm3, p < .001), and necrotic-core plaque volume (2.8 ± 6.4 vs 0.0 ± 0.1 mm3, p < .001). CONCLUSION. After propensity-score matching, 23% of patients with ACS had CAC0. Patients with CAC0 in the ACS and control groups showed significant differences in volumes of noncalcified plaque components. CLINICAL IMPACT. Methods that identify and quantify noncalcified plaque forms may help characterize ACS risk in symptomatic patients with CAC0.

ObjectivesTo report the association between kidney dysfunction and coronary artery calcification (CAC) score (CACS) among patients with clinically suspected coronary artery disease (CAD).MethodsWe prospectively included 1,572 consecutive patients with clinically...

Background: Statin use in adults with diabetes is sub-optimal. Coronary artery calcium (CAC) scoring can provide a visual quantification of CV risk and may improve statin initiation and long-term use. Objective: Estimate the cost-utility of CAC scoring compared to traditional CV risk counselling only, for improving statin use in adults with diabetes who have not previously had a CV event, and are not on statin therapy. Methods: Probabilistic Markov model from a health system perspective, over a 10-year time horizon. The effectiveness of CAC scoring was obtained from the EISNER trial. Outcomes included acute coronary syndrome (ACS), stroke, heart failure, mortality, and radiation-induced cancer. Outcome rates and costs were obtained from an analysis of Alberta administrative data, and from publicly available sources. The base population modeled was men age 60, with additional analyses for other age, sex-groups and scenarios. Results: CAC scoring increased statin use to 44% vs 25% with traditional CV risk counselling only. There were 8.4 fewer ACS, 5.5 fewer strokes, and 1.6 fewer deaths / 1000 individuals. Costs were slightly lower (-$14, 95% CI [-$402-(+$208)]) (CAD), for a small benefit in quality-adjusted life years (+0.01, [0.00-0.02]), with mean ICER of $7,132 (-$27,828-(+$65,513)) / QALY. At a willingness-to-pay of $50,000 / QALY, CAC was cost-effective in 95% of trials. CAC scoring was not cost-effective in younger men or in women, but could be cost-effective or cost savings in men (age ≥ 40) and older women (age ≥ 60) who refuse statin therapy, but would be persuaded by personalized evidence of coronary artery disease (CAC score &amp;gt; 10). Conclusion: CAC scoring may be cost-effective in older men not receiving statins, and in men or older women who agree to use statins if shown personalized evidence of coronary artery disease. Disclosure D.Lau: None. G.J.Pearson: Advisory Panel; HLS Therapeutics Inc., Novartis Pharmaceuticals Corporation, Pharmacience, Consultant; Trimedic Therapeutics. P.Raggi: None. S.Klarenbach: Research Support; Bayer Inc., Allergan, GlaxoSmithKline plc., CSL Behring, Lundbeck, University Hospital Foundation (University of Alberta), Purdue Canada.

HomeRadiologyVol. 261, No. 2 PreviousNext CommunicationsLetters to the EditorPredicting Major Coronary Events with Coronary Calcium Scoring and Coronary CT AngiographyKaren G. Ordovás*, Thomas B. Newman†, Antonio C. Westphalen*Karen G. Ordovás*, Thomas B. Newman†, Antonio C. Westphalen*Author AffiliationsDepartments of Radiology* and Epidemiology and Biostatistics,†University of California San Francisco, 505 Parnassus Ave, Room M-372, Box 0628, San Francisco, CA 94143 e-mail: [email protected]Karen G. Ordovás*Thomas B. Newman†Antonio C. Westphalen*Published Online:Nov 1 2011https://doi.org/10.1148/radiol.11111019MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References1 Kwon SW, Kim YJ, Shim Jet al.. Coronary artery calcium scoring does not add prognostic value to standard 64-section CT angiography protocol in low-risk patients suspected of having coronary artery disease. Radiology 2011;259(1):92–99. Link, Google Scholar2 Sodickson A, Baeyens PF, Andriole KPet al.. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology 2009;251(1):175–184. Link, Google Scholar3 U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Published May 17, 2011. Google ScholarArticle HistoryPublished online: Nov 2011Published in print: Nov 2011 FiguresReferencesRelatedDetailsRecommended Articles Invited Commentary: Coronary Artery Calcium Scoring—Simple Tool, Big ImpactRadioGraphics2022Volume: 42Issue: 4pp. E117-E118Coronary CT Angiography CAD-RADS versus Coronary Artery Calcium Score in Patients with Acute Chest PainRadiology2021Volume: 301Issue: 1pp. 81-90Prognostic Value of Combined CT Angiography and Myocardial Perfusion Imaging versus Invasive Coronary Angiography and Nuclear Stress Perfusion Imaging in the Prediction of Major Adverse Cardiovascular Events: The CORE320 Multicenter StudyRadiology2017Volume: 284Issue: 1pp. 55-65Prediction of Coronary Artery Calcium and Cardiovascular Risk on Chest Radiographs Using Deep LearningRadiology: Cardiothoracic Imaging2021Volume: 3Issue: 3Artificial Intelligence in Cardiovascular Imaging for Risk Stratification in Coronary Artery DiseaseRadiology: Cardiothoracic Imaging2021Volume: 3Issue: 1See More RSNA Education Exhibits Coronary Artery Calcium Scoring: Past, Present and FutureDigital Posters2020Evaluation of the Accuracy of Iodine-Enhanced Subtraction Myocardial Computed Tomography in the Diagnosis of Cardiac Sarcoidosis: Comparison with Cardiac Magnetic Resonance ImagingDigital Posters2018Spontaneous Coronary Artery Dissection (SCAD): An Uncommon Diagnosis of a Common Presentation - A Primer for the Cardiothoracic RadiologistsDigital Posters2020 RSNA Case Collection Anomalous origin of the right coronary artery from the left sinus of ValsalvaRSNA Case Collection2020Anomalous Left Coronary Artery from Pulmonary Artery (ALCAPA)RSNA Case Collection2020Chronic myocardial infarctionRSNA Case Collection2020 Vol. 261, No. 2 Metrics Altmetric Score PDF download

Background The effectiveness of aspirin (ASA) for primary prevention of major adverse cardiovascular events (MACE) in persons who smoke tobacco remains unclear, particularly among patients who underwent cardiac computed tomography angiography (CCTA) and coronary artery calcium scoring (CACS) due to suspected chronic coronary syndrome. Purpose To evaluate the risk of MACE and bleeding events across predefined CACS categories in relation to ASA use and smoking status. Methods A registry-based study of adult individuals (≥18 years of age) who underwent CCTA and CACS measurement from 2008-2022. Individuals were stratified by baseline ASA use (yes/no), CACS category (0, 1–99, 100–399, 400–999, ≥1000) and smoking status (current or prior versus no). Main exclusion criteria: history of acute coronary syndrome, coronary interventions, stroke, or treatment with ASA, anticoagulants, or P2Y12 inhibitors. The effectiveness endpoint was MACE, a composite of: death from any cause, non-fatal acute coronary syndrome, or non-fatal stroke, or revascularization. The safety endpoint was major bleeding requiring hospitalization. Follow-up began at 180 days after CCTA and ended upon event, emigration, death (for bleeding endpoint), or 2 years of follow-up, whichever came first. Absolute risks and risk differences (ASA vs no ASA) of the effectiveness and safety endpoints were computed using average treatment effect modelling with multivariable Cox regression analysis standardised to the distributions of age, sex and selected comorbidities. Results Of 65,519 included patients, 44.8% were non-smokers (25.7% used ASA), 55.2% were smokers (32.6% used ASA). Among non-smokers in lower CACS categories, no significant difference in the standardized absolute risk of MACE was observed between ASA users and non-users (all P for risk difference ≥0.05, Figure 1). ASA use was associated with a numerically lower absolute risk of MACE in patients with CACS 400-999 and ≥1000 (for 400-999: 3.5% [2.2% ; 4.7%] vs 4.6% [2.9% ; 6.3%] and for ≥1000: 4.8% [95% CI 2.8%; 6.7%] vs. 5.8% [95% CI 3.3%; 8.3%]), P=0.48. Bleeding risk did not differ significantly between ASA vs. no ASA (Figure 1). Among smokers, ASA use was not associated with a significant reduction in MACE risk across all CACS categories (all P for risk difference &amp;gt;0.05) In the CACS group ≥1000, event rates were similar between ASA users and non-users (8.8% [95% CI 6.8% ; 10.8%] vs. 8.0% [95% CI 5.8% ; 10.3%], P=0.58). Bleeding risks in the smoking group were generally higher with ASA use across all CACS levels, except for those with CACS ≥1000. In general, smokers had numerically higher MACE and bleeding risks than non-smokers (Figure 1). Conclusion ASA use for primary prevention was not associated with reduced risk of MACE across CACS categories or with a significant impact on bleeding risk in smokers and non-smokers undergoing CCTA. These findings suggest that ASA may have limited preventive effects in this population.Figure 1

Background: The COVID-19 pandemic has had significant long-term health implications, including potential cardiovascular complications such as accelerated coronary artery disease (CAD). This study investigates the relationship between COVID-19 severity and coronary artery calcium (CAC) scores, which measure calcified atherosclerotic plaque in the coronary arteries, a key predictor of future cardiovascular events. Understanding this relationship can inform cardiovascular risk management in post-COVID-19 patients. This study aims to Aims &amp; Objectives: evaluate CT calcium scores in post-COVID-19 patients and determine the association between COVID-19 severity and coronary artery calcification. Additionally, it seeks to assess the impact of age, comorbidities, and respiratory support on CAC scores. This retrospective Methods: cohort study involved 60 post-COVID-19 patients from CSS Hospital, Subharti Medical College, Meerut. Data on demographic, clinical, and laboratory variables were collected, and CT calcium scores were measured using computed tomography (CT) angiography. Statistical analyses were conducted to evaluate the relationships between CAC scores and COVID-19 severity, age, comorbidities, and respiratory support. A Results: strong positive correlation (r=0.808, p&lt;0.001) was found between severe COVID-19 and higher CAC scores, especially in patients over 50. Comorbidities such as T2DM and HTN did not significantly influence CAC scores. Higher calcium scores were associated with ICU admissions, though not with hospitalization. No significant gender differences in CAC scores were observed. Sever Conclusions: e COVID-19 is associated with elevated CAC scores, indicating higher cardiovascular risk in these patients. Further research is needed to explore the long-term cardiovascular implications in post-COVID-19 patients.

Background The association between known cardiovascular risk factors and poor prognosis of patients diagnosed with coronavirus disease 2019 (COVID-19) has been recently emphasized (1). Coronary artery calcium (CAC) score assessed by computed tomography (CT) is considered a risk modifier in primary prevention of cardiovascular disease and has shown to improve cardiovascular risk prediction in addition to classical risk factors (2). Purpose We hypothesized that the absence of CAC might have an additional predictive value for an improved cardiovascular outcome of hospitalized COVID-19 patients. Methods We prospectively included 310 consecutive hospitalized patients with COVID-19. Thirty patients with a history of coronary artery disease were excluded.Low dose non-contrast chest CT was performed in all patients at admission. Visual assessment of CAC in every coronary artery was obtained by using an ordinal scoring of 0, 1, 2 or 3 corresponding to absent, mild, moderate or severe CAC score. A total score was calculated by summing the score of each vessel, which was further categorized as 0 (undetectable), 1–3 (mild), 4–5 (moderate) and ≥6 (severe). (Figure 1). Demographics, medical history, clinical characteristics, laboratory findings, imaging data, in–hospital treatment and outcomes were retrospectively analyzed. A composite endpoint of major adverse cardiovascular events (MACE) was defined as all-cause mortality and cardiovascular events (heart failure, myocarditis, arrhythmia, acute coronary syndrome, stroke, pulmonary embolism). Results Two-hundred eighty patients (63.2±16.7 years old, 57.5% male) were included in the analysis. One hundred thirty one (46.7%) patients had a CAC score of zero. MACE-rate was 24.2% (68 patients). Multivariate logistic regression showed that the absence of CAC was inversely associated with MACE (OR 0.264, 95% 0.071–0.981, p=0.047), with a negative predictive value (NPV) of 81.4%, sensitivity 70%, specificity 55%, independent of age, risk factors or disease severity (Table 1). Conclusion The absence of CAC translated into a low risk for MACE in COVID-19 patients, even in the presence of cardiac risk factors, which reinforces the idea that the assessment of CAC score in COVID-19 patients could be a useful marker for patients risk stratification and management. Future directions should focus on the implementation of CAC score into mid-term and long-term follow-up of this particular population, to provide a more precise and earlier estimation of cardiovascular risk Funding Acknowledgement Type of funding sources: None. Figure 1Table 1

Background and Aims Previous studies evidenced that elevated coronary artery calcium (CAC) score is associated with higher chronic kidney disease (CKD) progression. However, the use of CAC score to guide CKD management has not been adequately evaluated. Here, we evaluated whether presence of CAC modify the association between systolic blood pressure (SBP) and CKD progression in patients with CKD. Method We analyzed 1693 participants with CKD stages G1 to G5 from the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD). Key exclusion criteria were kidney failure with replacement therapy (KFRT) and missing data for CAC and SBP information. We categorized participants according to baseline SBP and CAC score (Controlled BP, SBP &amp;lt; 120 mmHg; Elevated BP without CAC, SBP 120-140 mmHg and CAC score = 0; Elevated BP with CAC, SBP 120-140 mmHg and CAC score &amp;gt;0; Uncontrolled BP, SBP &amp;gt;140 mmHg) and compared the CKD progression. The CKD progression was defined as a composite of halving eGFR from baseline value or onset of KFRT. Results During 10,023 person-years of follow-up (median 6.2 years), the composite outcome occurred in 689 (40.7%) participants, and 108 (6.4%) participants died among the KNOW-CKD participants. There was significant interaction between CAC score and SBP for CKD progression (P &amp;lt; 0.001). There were 181/568 (31.9%), 167/424 (39.4%), 128/314 (40.8%) 213/387 (55.0%), composite outcomes in controlled BP, elevated BP without CAC, elevated BP with CAC, uncontrolled BP group, respectively. In crude Cox regression, compared to controlled BP, elevated BP with CAC group showed similar CKD progression risk (Hazard ratio [HR], 1.17; 95% confidence interval [CI], 0.95-1.44), whereas other strata group showed increased risk of CKD progression (elevated BP with CAC; HR, 1.59; 95% CI 1.31-1.94 and uncontrolled BP, HR, 1.94; 95% CI 1.56-2.41). Similar elevated risk in elevated BP with CAC was observed even after adjustment of age, sex, diabetes mellitus, estimated glomerular filtration ratio, and proteinuria (HR, 1.26; 95% CI, 1.02-1.56). However, the risk of CKD progression in elevated BP without CAC group was comparable to controlled BP group (HR, 1.20; 95% CI, 0.87-1.66). Conclusion Elevated SBP was more strongly associated with an increased risk of adverse kidney outcomes in patients with coronary calcification.

Heart Disease and Stroke Statistics—2009 Update

ObjectivesTo evaluate the prognostic value of the coronary artery calcium (CAC) score in patients with stable angina pectoris (SAP) who underwent percutaneous coronary intervention (PCI).MethodsA total of 334 consecutive patients with SAP who underwent first PCI following multi-slice computer tomography (MSCT) were enrolled from our institution between January 2007 and June 2012. The CAC score was calculated according to the standard Agatston calcium scoring algorithm. Complex PCI was defined as use of high pressure balloon, kissing balloon and/or rotablator. Procedure-related complications included dissection, occlusion, perforation, no/slow flow and emergency coronary artery bypass grafting. Main adverse cardiac events (MACE) were defined as a combined end point of death, non-fatal myocardial infarction, target lesion revascularization and rehospitalization for cardiac ischemic events.ResultsPatients with a CAC score > 300 (n = 145) had significantly higher PCI complexity (13.1% vs. 5.8%, P = 0.017) and rate of procedure-related complications (17.2% vs. 7.4%, P = 0.005) than patients with a CAC score ≤ 300 (n = 189). After a median follow-up of 22.5 months (4–72 months), patients with a CAC score ≤ 300 differ greatly than those patients with CAC score > 300 in cumulative non-events survival rates (88.9 vs. 79.0%, Log rank 4.577, P = 0.032). After adjusted for other factors, the risk of MACE was significantly higher [hazard ratio (HR): 4.3, 95% confidence interval (95% CI): 2.4–8.2, P = 0.038] in patients with a CAC score > 300 compared to patients with a lower CAC score.ConclusionsThe CAC score is an independent predictor for MACE in SAP patients who underwent PCI and indicates complexity of PCI and procedure-related complications.

ObjectiveWe investigated the predictive value of clinical factors combined with coronary artery calcium (CAC) score based on a machine learning method for obstructive coronary heart disease (CAD) on coronary computed tomography angiography (CCTA) in individuals with atypical chest pain.MethodsThe study included data from 1,906 individuals undergoing CCTA and CAC scanning because of atypical chest pain and without evidence for the previous CAD. A total of 63 variables including traditional cardiovascular risk factors, CAC score, laboratory results, and imaging parameters were used to build the Random forests (RF) model. Among all the participants, 70% were randomly selected to train the models on which fivefold cross-validation was done and the remaining 30% were regarded as a validation set. The prediction performance of the RF model was compared with two traditional logistic regression (LR) models.ResultsThe incidence of obstructive CAD was 16.4%. The area under the receiver operator characteristic (ROC) for obstructive CAD of the RF model was 0.841 (95% CI 0.820–0.860), the CACS model was 0.746 (95% CI 0.722–0.769), and the clinical model was 0.810 (95% CI 0.788–0.831). The RF model was significantly superior to the other two models (p < 0.05). Furthermore, the calibration curve and Hosmer–Lemeshow test showed that the RF model had good classification performance (p = 0.556). CAC score, age, glucose, homocysteine, and neutrophil were the top five important variables in the RF model.ConclusionRF model was superior to the traditional models in the prediction of obstructive CAD. In clinical practice, the RF model may improve risk stratification and optimize individual management.