Coronary calcium level is a better predictor of blocked coronary arteries at risk for a heart attack
Testing a patient’s coronary calcium levels is a better predictor of blocked coronary arteries at risk for a heart attack, claims a new study.
It can also assess the need for revascularization better than standard risk-assessment equations used in medical practice today.
Cardiovascular disease remains the greatest cause of morbidity and mortality the world over. According to the first state level disease burden study 2017, ischaemic heart disease was the leading cause of death in India in 2016.
Researchers identified 1,107 symptomatic patients without any known coronary artery disease. They had a PET-stress test to measure coronary flow, conducted as part of their diagnostic evaluation.
The PET/CT test also enabled a coronary calcium score to be measured. Based on the coronary calcium score and standard risk factors documented in their medical records, three different cardiovascular disease risk scores were calculated: the standard Pooled Cohort Equation (based on traditional risk factors), the Multi-Ethnic Study of Atherosclerosis (MESA) Risk Score (which combines coronary calcium and traditional risk factors), and the Coronary Calcium Score alone.
Noteworthy though was that of the 29 patients who showed no coronary artery calcium, none had any major heart problems in the time-period tracked.
Researchers tracked those patients to identify who, based on PET scan results suggesting a blocked artery, went on to revascularization (a coronary stent or bypass surgery) and who had a subsequent heart attack or died during the subsequent two years.
Results showed that risk equations that included coronary artery calcium measurements, i.e., the MESA Score and the Coronary Calcium Risk Score, were better able to predict the presence of symptomatic coronary artery disease requiring revascularization than the Pooled Cohort Equation, which relies only on standard risk factors such as age, gender, blood pressure, and cholesterol measurements.
However, all three equations were only moderately successful in determining who over two years of follow-up would go on to die or have a heart attack. Noteworthy though was that of the 29 patients who showed no coronary artery calcium, none had any major heart problems in the time-period tracked.
Researchers presented results from the study at the American Heart Association’s 2018 Scientific Session in Chicago.
“Calcium in the artery doesn’t tell you the extent of soft plaque, but it does mark that disease is present,” said Dr. Jeffrey L. Anderson, MD, a cardiologist and cardiovascular researcher at the Intermountain Medical Center Heart Institute in Salt Lake City. “These results tell us that coronary calcium adds importantly to probability estimates.”