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Performance of the coronary calcium score in an outpatient chest pain clinic and strategies for risk stratification
BACKGROUND: Coronary artery calcium score (CAC) is an objective marker of atherosclerosis. The primary aim is to assess CAC as a risk classifier in stable coronary artery disease (CAD). HYPOTHESIS: CAC improves CAD risk prediction, compared to conventional risk scoring, even in the absence of cardio...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wiley Periodicals, Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852173/ https://www.ncbi.nlm.nih.gov/pubmed/33434373 http://dx.doi.org/10.1002/clc.23539 |
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author | Huang, Weiting Lim, Leon Ming Hsien Aurangzeb, Amirzeb S/O. Wong, Cheney Jianlin Koh, Natalie Si Ya Huang, Zijuan Teo, Hooi Khee Chua, Terrance Siang Jin Tan, Swee Yaw |
author_facet | Huang, Weiting Lim, Leon Ming Hsien Aurangzeb, Amirzeb S/O. Wong, Cheney Jianlin Koh, Natalie Si Ya Huang, Zijuan Teo, Hooi Khee Chua, Terrance Siang Jin Tan, Swee Yaw |
author_sort | Huang, Weiting |
collection | PubMed |
description | BACKGROUND: Coronary artery calcium score (CAC) is an objective marker of atherosclerosis. The primary aim is to assess CAC as a risk classifier in stable coronary artery disease (CAD). HYPOTHESIS: CAC improves CAD risk prediction, compared to conventional risk scoring, even in the absence of cardiovascular risk factor inputs. METHODS: Outpatients presenting to a cardiology clinic (n = 3518) were divided into two cohorts: derivation (n = 2344 patients) and validation (n = 1174 patients). Adding logarithmic transformation of CAC, we built two logistic regression models: Model 1 with chest pain history and risk factors and Model 2 including chest pain history only without risk factors simulating patients with undiagnosed comorbidities. The CAD I Consortium Score (CCS) was the conventional reference risk score used. The primary outcome was the presence of coronary artery disease defined as any epicardial artery stenosis≥50% on CT coronary angiogram. RESULTS: Area under curve (AUC) of CCS in our validation cohort was 0.80. The AUC of Models 1 and 2 were significantly improved at 0.88 (95%CI 0.86–0.91) and 0.87 (95%CI 0.84–0.90), respectively. Integrated discriminant improvement was >15% for both models. At a pre‐specified cut‐off of ≤10% for excluding coronary artery disease, the sensitivity and specificity were 89.3% and 74.7% for Model 1, and 88.1% and 71.8% for Model 2. CONCLUSION: CAC helps improve risk classification in patients with chest pain, even in the absence of prior risk factor screening. |
format | Online Article Text |
id | pubmed-7852173 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Wiley Periodicals, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-78521732021-02-05 Performance of the coronary calcium score in an outpatient chest pain clinic and strategies for risk stratification Huang, Weiting Lim, Leon Ming Hsien Aurangzeb, Amirzeb S/O. Wong, Cheney Jianlin Koh, Natalie Si Ya Huang, Zijuan Teo, Hooi Khee Chua, Terrance Siang Jin Tan, Swee Yaw Clin Cardiol Clinical Investigations BACKGROUND: Coronary artery calcium score (CAC) is an objective marker of atherosclerosis. The primary aim is to assess CAC as a risk classifier in stable coronary artery disease (CAD). HYPOTHESIS: CAC improves CAD risk prediction, compared to conventional risk scoring, even in the absence of cardiovascular risk factor inputs. METHODS: Outpatients presenting to a cardiology clinic (n = 3518) were divided into two cohorts: derivation (n = 2344 patients) and validation (n = 1174 patients). Adding logarithmic transformation of CAC, we built two logistic regression models: Model 1 with chest pain history and risk factors and Model 2 including chest pain history only without risk factors simulating patients with undiagnosed comorbidities. The CAD I Consortium Score (CCS) was the conventional reference risk score used. The primary outcome was the presence of coronary artery disease defined as any epicardial artery stenosis≥50% on CT coronary angiogram. RESULTS: Area under curve (AUC) of CCS in our validation cohort was 0.80. The AUC of Models 1 and 2 were significantly improved at 0.88 (95%CI 0.86–0.91) and 0.87 (95%CI 0.84–0.90), respectively. Integrated discriminant improvement was >15% for both models. At a pre‐specified cut‐off of ≤10% for excluding coronary artery disease, the sensitivity and specificity were 89.3% and 74.7% for Model 1, and 88.1% and 71.8% for Model 2. CONCLUSION: CAC helps improve risk classification in patients with chest pain, even in the absence of prior risk factor screening. Wiley Periodicals, Inc. 2021-01-12 /pmc/articles/PMC7852173/ /pubmed/33434373 http://dx.doi.org/10.1002/clc.23539 Text en © 2021 The Authors. Clinical Cardiology published by Wiley Periodicals LLC. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Clinical Investigations Huang, Weiting Lim, Leon Ming Hsien Aurangzeb, Amirzeb S/O. Wong, Cheney Jianlin Koh, Natalie Si Ya Huang, Zijuan Teo, Hooi Khee Chua, Terrance Siang Jin Tan, Swee Yaw Performance of the coronary calcium score in an outpatient chest pain clinic and strategies for risk stratification |
title | Performance of the coronary calcium score in an outpatient chest pain clinic and strategies for risk stratification |
title_full | Performance of the coronary calcium score in an outpatient chest pain clinic and strategies for risk stratification |
title_fullStr | Performance of the coronary calcium score in an outpatient chest pain clinic and strategies for risk stratification |
title_full_unstemmed | Performance of the coronary calcium score in an outpatient chest pain clinic and strategies for risk stratification |
title_short | Performance of the coronary calcium score in an outpatient chest pain clinic and strategies for risk stratification |
title_sort | performance of the coronary calcium score in an outpatient chest pain clinic and strategies for risk stratification |
topic | Clinical Investigations |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852173/ https://www.ncbi.nlm.nih.gov/pubmed/33434373 http://dx.doi.org/10.1002/clc.23539 |
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