Ethan Lin MD , Rea Alonzo MSc , Jiming Fang PhD , Anna Chu MHSc , Levi Elhadad BSc , Maneesh Sud MD, PhD , Harindra C. Wijeysundera MD, PhD , Shalane Basque MSc , Kate Hanneman MD, MPH , Elsie Nguyen MD , Michael E. Farkouh MD, MSc , Jacob A. Udell MD, MSc , Idan Roifman MD, MSc
{"title":"Impact of Zero Coronary Artery Calcium Scoring on Downstream Cardiac Testing and Cardiac Outcomes Compared With No Testing","authors":"Ethan Lin MD , Rea Alonzo MSc , Jiming Fang PhD , Anna Chu MHSc , Levi Elhadad BSc , Maneesh Sud MD, PhD , Harindra C. Wijeysundera MD, PhD , Shalane Basque MSc , Kate Hanneman MD, MPH , Elsie Nguyen MD , Michael E. Farkouh MD, MSc , Jacob A. Udell MD, MSc , Idan Roifman MD, MSc","doi":"10.1016/j.cjco.2024.11.009","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The impact of coronary artery calcium (CAC) scoring on downstream resource utilisation and outcomes remains unclear, especially in those with zero CAC.</div></div><div><h3>Methods</h3><div>Consecutive CAC scores from two academic hospitals in Toronto, Ontario, were linked to population-based databases. Subjects with zero CAC without previous cardiovascular disease were propensity score matched with a non–CAC-tested control group for age, sex, cardiovascular risk factors, and comorbidities. Downstream cardiac testing, acute myocardial infarction, heart failure (HF) hospitalisations, and HF emergency department (ED) visits were compared between the 2 groups.</div></div><div><h3>Results</h3><div>A total of 4884 patients underwent CAC scoring, of whom 2709 had zero CAC (mean 52.9 ± 10.6 years), 55.4% women. At 3.4 years, graded-stress testing (hazard ratio [HR] 1.24, 95% confidence interval [95% CI] 1.14-1.35), stress echocardiography (HR 1.80, 95% CI 1.59-2.05), and cardiac magnetic resonance imaging (HR 3.40, 95% CI 2.55-4.53) use was higher in the zero CAC group, whereas myocardial perfusion scintigraphy (HR 1.08, 95% CI 0.97-1.21) and catheterisation (HR 1.14, 95% CI 0.91-1.44) were similar and percutaneous coronary intervention (HR 0.58, 95% CI 0.35-0.98) and coronary artery bypass grafting (HR 0.14, 95% CI 0.03-0.61) were lower. There was an approximately 5-fold lower rate of myocardial infarction (HR 0.22, 95% CI 0.10-0.51) in the zero CAC group and no difference in HF hospitalisations (HR 1.15, CI 95% 0.53-2.48) or ED admissions (HR 1.21, 95% CI 0.58-2.52).</div></div><div><h3>Conclusions</h3><div>Our results support the utility of zero CAC in limiting interventional cardiovascular procedures while maintaining an association with reduced downstream cardiovascular events.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 2","pages":"Pages 211-220"},"PeriodicalIF":2.5000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"CJC Open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589790X24005869","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/11/19 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background
The impact of coronary artery calcium (CAC) scoring on downstream resource utilisation and outcomes remains unclear, especially in those with zero CAC.
Methods
Consecutive CAC scores from two academic hospitals in Toronto, Ontario, were linked to population-based databases. Subjects with zero CAC without previous cardiovascular disease were propensity score matched with a non–CAC-tested control group for age, sex, cardiovascular risk factors, and comorbidities. Downstream cardiac testing, acute myocardial infarction, heart failure (HF) hospitalisations, and HF emergency department (ED) visits were compared between the 2 groups.
Results
A total of 4884 patients underwent CAC scoring, of whom 2709 had zero CAC (mean 52.9 ± 10.6 years), 55.4% women. At 3.4 years, graded-stress testing (hazard ratio [HR] 1.24, 95% confidence interval [95% CI] 1.14-1.35), stress echocardiography (HR 1.80, 95% CI 1.59-2.05), and cardiac magnetic resonance imaging (HR 3.40, 95% CI 2.55-4.53) use was higher in the zero CAC group, whereas myocardial perfusion scintigraphy (HR 1.08, 95% CI 0.97-1.21) and catheterisation (HR 1.14, 95% CI 0.91-1.44) were similar and percutaneous coronary intervention (HR 0.58, 95% CI 0.35-0.98) and coronary artery bypass grafting (HR 0.14, 95% CI 0.03-0.61) were lower. There was an approximately 5-fold lower rate of myocardial infarction (HR 0.22, 95% CI 0.10-0.51) in the zero CAC group and no difference in HF hospitalisations (HR 1.15, CI 95% 0.53-2.48) or ED admissions (HR 1.21, 95% CI 0.58-2.52).
Conclusions
Our results support the utility of zero CAC in limiting interventional cardiovascular procedures while maintaining an association with reduced downstream cardiovascular events.
背景冠状动脉钙（CAC）评分对下游资源利用和预后的影响尚不清楚，特别是对那些没有CAC的患者。方法将安大略省多伦多市两家学术医院的连续CAC评分与基于人群的数据库相关联。无CAC且既往无心血管疾病的受试者在年龄、性别、心血管危险因素和合并症方面与未检测CAC的对照组进行倾向评分匹配。比较两组患者的下游心脏试验、急性心肌梗死、心力衰竭住院和心力衰竭急诊科就诊情况。结果4884例患者接受CAC评分，其中2709例患者无CAC（平均52.9±10.6岁），女性55.4%。在3.4年时，分级应激测试（风险比[HR] 1.24, 95%可信区间[95% CI] 1.14-1.35）、应激超声心动图（HR 1.80, 95% CI 1.59-2.05）和心脏磁共振成像（HR 3.40, 95% CI 2.55-4.53）的使用在无CAC组较高，而心肌灌注显像（HR 1.08, 95% CI 0.97-1.21）和导管插管（HR 1.14, 95% CI 0.91-1.44）相似，经皮冠状动脉介入治疗(HR 0.58，95% CI 0.35-0.98)和冠状动脉旁路移植术（HR 0.14, 95% CI 0.03-0.61）较低。无CAC组心肌梗死发生率降低约5倍（HR 0.22, 95% CI 0.10-0.51），心衰住院率（HR 1.15, 95% CI 0.53-2.48）或ED入院率（HR 1.21, 95% CI 0.58-2.52）无差异。结论：我们的研究结果支持零CAC在限制介入心血管手术的同时保持与减少下游心血管事件的关联。
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