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The Added Value of a High CT Coronary Artery Calcium Score in the Management of Patients Presenting with Acute Chest Pain vs. Stable Chest Pain

Background: Contrast computerized tomography (CT) scan is occasionally aborted due to a high coronary artery calcium score (CACS). For the same CACS in our clinical practice, we observed a higher occurrence of severe coronary artery disease (CAD) in patients with acute chest pain (ACP) compared to p...

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Autores principales: Hitter, Rafael, Orlev, Amir, Amsalem, Itshak, Levi, Nir, Wolak, Talya, Farkash, Rivka, Bogot, Naama, Glikson, Michael, Wolak, Arik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9694127/
https://www.ncbi.nlm.nih.gov/pubmed/36421925
http://dx.doi.org/10.3390/jcdd9110390
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author Hitter, Rafael
Orlev, Amir
Amsalem, Itshak
Levi, Nir
Wolak, Talya
Farkash, Rivka
Bogot, Naama
Glikson, Michael
Wolak, Arik
author_facet Hitter, Rafael
Orlev, Amir
Amsalem, Itshak
Levi, Nir
Wolak, Talya
Farkash, Rivka
Bogot, Naama
Glikson, Michael
Wolak, Arik
author_sort Hitter, Rafael
collection PubMed
description Background: Contrast computerized tomography (CT) scan is occasionally aborted due to a high coronary artery calcium score (CACS). For the same CACS in our clinical practice, we observed a higher occurrence of severe coronary artery disease (CAD) in patients with acute chest pain (ACP) compared to patients with stable chest pain (SCP). Since it is known that ACP differs in many ways from SCP, the aim of this study was to compare the predictive value of a high CACS for the diagnosis of severe CAD between ACP and SCP patients. Methods: This single center observational retrospective study included consecutive patients who underwent cardiac CT for chest pain and were found to have a CACS of >200 Agatston units. Patients were divided into two groups, ACP and SCP. Severe CAD was defined as ≥70% stenosis on coronary CT angiography or invasive coronary angiography. Baseline characteristics and final diagnosis of severe CAD were compared. Results: The cohort included 220 patients, 106 with ACP and 114 with SCP. ACP patients had higher severe CAD rates (60.4% vs. 36.8%; p < 0.001). On multivariate analysis including cardiac risk factors, CACS > 400 au (OR = 2.34 95% CI [1.32–4.15]; p = 0.004) and ACP (OR = 2.54 95% CI [1.45–4.45]; p = 0.001) were independent predictors of severe CAD. The addition of the clinical setting of ACP added significant incremental predictive value for severe stenosis. Conclusion: A high CACS is more associated with severe CAD in patients presenting with ACP than SCP. The findings suggest that the CACS could impact the management of patients during the scan.
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spelling pubmed-96941272022-11-26 The Added Value of a High CT Coronary Artery Calcium Score in the Management of Patients Presenting with Acute Chest Pain vs. Stable Chest Pain Hitter, Rafael Orlev, Amir Amsalem, Itshak Levi, Nir Wolak, Talya Farkash, Rivka Bogot, Naama Glikson, Michael Wolak, Arik J Cardiovasc Dev Dis Article Background: Contrast computerized tomography (CT) scan is occasionally aborted due to a high coronary artery calcium score (CACS). For the same CACS in our clinical practice, we observed a higher occurrence of severe coronary artery disease (CAD) in patients with acute chest pain (ACP) compared to patients with stable chest pain (SCP). Since it is known that ACP differs in many ways from SCP, the aim of this study was to compare the predictive value of a high CACS for the diagnosis of severe CAD between ACP and SCP patients. Methods: This single center observational retrospective study included consecutive patients who underwent cardiac CT for chest pain and were found to have a CACS of >200 Agatston units. Patients were divided into two groups, ACP and SCP. Severe CAD was defined as ≥70% stenosis on coronary CT angiography or invasive coronary angiography. Baseline characteristics and final diagnosis of severe CAD were compared. Results: The cohort included 220 patients, 106 with ACP and 114 with SCP. ACP patients had higher severe CAD rates (60.4% vs. 36.8%; p < 0.001). On multivariate analysis including cardiac risk factors, CACS > 400 au (OR = 2.34 95% CI [1.32–4.15]; p = 0.004) and ACP (OR = 2.54 95% CI [1.45–4.45]; p = 0.001) were independent predictors of severe CAD. The addition of the clinical setting of ACP added significant incremental predictive value for severe stenosis. Conclusion: A high CACS is more associated with severe CAD in patients presenting with ACP than SCP. The findings suggest that the CACS could impact the management of patients during the scan. MDPI 2022-11-13 /pmc/articles/PMC9694127/ /pubmed/36421925 http://dx.doi.org/10.3390/jcdd9110390 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Hitter, Rafael
Orlev, Amir
Amsalem, Itshak
Levi, Nir
Wolak, Talya
Farkash, Rivka
Bogot, Naama
Glikson, Michael
Wolak, Arik
The Added Value of a High CT Coronary Artery Calcium Score in the Management of Patients Presenting with Acute Chest Pain vs. Stable Chest Pain
title The Added Value of a High CT Coronary Artery Calcium Score in the Management of Patients Presenting with Acute Chest Pain vs. Stable Chest Pain
title_full The Added Value of a High CT Coronary Artery Calcium Score in the Management of Patients Presenting with Acute Chest Pain vs. Stable Chest Pain
title_fullStr The Added Value of a High CT Coronary Artery Calcium Score in the Management of Patients Presenting with Acute Chest Pain vs. Stable Chest Pain
title_full_unstemmed The Added Value of a High CT Coronary Artery Calcium Score in the Management of Patients Presenting with Acute Chest Pain vs. Stable Chest Pain
title_short The Added Value of a High CT Coronary Artery Calcium Score in the Management of Patients Presenting with Acute Chest Pain vs. Stable Chest Pain
title_sort added value of a high ct coronary artery calcium score in the management of patients presenting with acute chest pain vs. stable chest pain
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9694127/
https://www.ncbi.nlm.nih.gov/pubmed/36421925
http://dx.doi.org/10.3390/jcdd9110390
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