- The study evaluated 243 patients without known heart disease using coronary CT scans to detect silent coronary artery disease. - 54% of patients were found to have coronary atherosclerosis. - Patients who showed signs of atherosclerosis on CT scans had a 7.2 times higher risk of cardiovascular events compared to those without atherosclerosis. - CT scans were found to provide better prediction of future cardiovascular risks than traditional clinical risk scores, reclassifying many patients from low to high risk.

1. Clínica CIMA
Prognostic value of detection of silent coronary
artery disease by computed tomographic scan
Dr Cèsar Morcillo MD, PhD
Internal Medicine
Hospital Cima
Barcelona, Spain

2. Clínica CIMA
Abrams J. N Engl J Med 2005;352:2524-2533
Prognostic value of detection of silent coronary
artery disease by computed tomographic scan

3. Clínica CIMA
The SCORE project.
Eur Heart J 2003;24:987
Prognostic value of detection of silent coronary
artery disease by computed tomographic scan

4. Add anything to make a coronary CT scan?
Prognostic value of detection of silent coronary
artery disease by computed tomographic scan

5. Coronary Calcium Score CT coronary angiography
Prognostic value of detection of silent coronary
artery disease by computed tomographic scan

6. Clínica CIMA
• Methods:
– 243 patients without known atherosclerosis.
– All patients were studied with coronary CT scan:
Coronary Calcium Score and CT coronary angiography.
– Follow-up: 6.8 years.
– Objective: to compare presented cardiovascular events
with estimated with REGICOR and SCORE functions.
Prognostic value of detection of silent coronary
artery disease by computed tomographic scan

7. Clínica CIMA
• Results:
– 54% had coronary atherosclerosis.
47%
54%
Prognostic value of detection of silent coronary
artery disease by computed tomographic scan

8. Clínica CIMA
• Results:
Prognostic value of detection of silent coronary
artery disease by computed tomographic scan
Variables
demográficas
Detección de Arterioesclerosis por TCDM Eventos
Toda la muestra
(n=243)
n (%)
No
(n=113)
n (%)
Sí
(n=130)
n (%)
p
No
(n=226)
n (%)
Sí
(n=17)
n (%)
p
Edad media (DE) 55,4 50,2 (8.0) 60,0 (9,5) p<0,001 54,8 (9,8) 64,0 (10,9) p<0,001
Hombre 219 (90,1%) 102 (90,3%) 117 (90,0%) p=0,945 204 (90,3%) 15 (88,2%) p=0,787
Fumador o exfumador 157 (64,6%) 62 (54,9%) 95 (73,1%) p=0,003 147 (65,0%) 10 (58,8%) p=0,605
Sedentarismo 58 (23,9%) 27 (23,9%) 31 (23,8%) p=0,993 51 (22,6%) 7 (41,2%) p=0,083
Dislipemia 98 (40,3%) 33 (29,2%) 65 (50,0%) p=0,001 90 (39,8%) 8 (47,1%) p=0,558
Hipertensión 80 (32,9%) 23 (20,4%) 57 (43,8%) p<0,001 68 (30,1%) 12 (70,6%) p=0,001
Diabetes Mellitus 9 (3,7%) 3 (2,7%) 6 (4,6%) p=0,509 7 (3,1%) 2 (11,8%) p=0,124
Obesidad 38 (15,6%) 13 (11,5%) 25 (19,2%) p=0,098 34 (15,0%) 4 (23,5%) p=0,315
Hombre > 55 años 98 (40,3%) 23 (20,4%) 75 (57,7%) p<0,001 86 (38,1%) 12 (70,6%) p=0,008
Mujer > 65 años 7 (2,9%) 1 (0,9%) 6 (4,6%) p=0,126 6 (2,7%) 1 (5,9%) p=0,402
Historia familiar de
enfermedad coronaria
28 (11,5%) 7 (6,2%) 21 (16,2%) p=0,015 27 (11,9%) 1 (5,9%) p=0,701

9. Clínica CIMA
• Results:
Prognostic value of detection of silent coronary
artery disease by computed tomographic scan
Coronary Calcium Score

10. Clínica CIMA
!
• CT coronary angiography predict cardiovascular
events and have incremental prognostic value
beyond clinical risk scores.
• Detection of silent coronary atherosclerosis
increases the risk of having an event 7,2 times more
than those without atherosclerosis.
• This predictive power is greater than REGICOR
(OR: 4,341) and SCORE (OR: 2,864).
• Results:
Prognostic value of detection of silent coronary
artery disease by computed tomographic scan

11. Clínica CIMA
• Results:
Prognostic value of detection of silent coronary
artery disease by computed tomographic scan
Detección de Arterioesclerosis por TCDM
Toda la muestra
(n=243)
n (%)
No
(n=113)
n (%)
Sí
(n=130)
n (%)
p
Riesgo SCORE
Bajo 109 (47,2%) 75 (68,2%) 34 (28,1%)
p<0,001Intermedio 89 (38,5%) 31 (28,2%) 58 (47,9%)
Alto 33 (14,3%) 4 (3,6%) 29 (24%)
Riesgo REGICOR
Bajo 127 (56,7%) 79 (73,1%) 48 (41,4%)
p<0,001Intermedio 86 (38,4%) 25 (23,1%) 61 (52,6%)
Alto 11 (4,9%) 4 (3,7%) 7 (6,0%)

12. Clínica CIMA
!
• 54% patients had coronary atherosclerosis.
• CT coronary angiography predicts cardiovascular events:
– More events at higher calcium score.
– Detection of silent coronary atherosclerosis increases the risk of
having an event 7,2 times more than those without atherosclerosis.
• CT coronary angiography has incremental prognostic value beyond
clinical risk scores.
• 76% low-intermediate SCORE risk patients (94% with REGICOR)
already had atherosclerosis and should be reclassified to high risk.
• Conclusions:
Prognostic value of detection of silent coronary
artery disease by computed tomographic scan