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KMID : 0882420100780040466
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Korean Journal of Medicine
2010 Volume.78 No. 4 p.466 ~ p.476
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Clinical outcomes according to coronary calcium scores in asymptomatic individuals undergoing coronary CT angiography
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Jung In-Hyun
Kim Jeong-Soon
Nam Hyo-Jung
Kim Hong-Kyu
Park Duk-Woo
Lee Seung-Whan
Kim Young-Hak
Lee Cheol-Whan
Kim Jae-Joong
Park Seong-Wook
Park Seung-Jung
Kang Joon-Won
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Abstract
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Background/Aims : In general, multidetector computed tomography (MDCT) is not recommended as a screening tool for asymptomatic individuals. However, the programs for general health evaluation at several hospitals in Korea include MDCT to detect cardiac disease. The objectives of this study were to evaluate the clinical outcomes of asymptomatic individuals according to the coronary artery calcium score (CACS) obtained from screening MDCT and to assess the eligibility of risk stratification in the NCEP-ATP III guidelines for predicting a significant stenosis on MDCT.
Methods: We reviewed the medical records of 845 asymptomatic subjects (age 53±9 years, 67% men) who underwent MDCT as part of a general health evaluation at Asan Medical Center, Seoul, Korea, from January to December 2008.
Results: Atherosclerotic plaques were identified in 332 (39.3%) subjects. Sixty (7.1%) individuals had significant stenosis (≥ 50% diameter stenosis). The prevalence of significant stenosis was higher in the group that had more than a 10% risk of coronary heart disease (CHD) at 10 years (p<0.05). Among the patients with occult coronary artery disease (CAD), 28 received coronary angiography, which resulted in 20 revascularizations (17 percutaneous interventions and three bypass surgeries) and eight medical treatments. In patients with significant narrowing, the CACS cutoff value for predicting coronary revascularization was 111.0 (AUC=0.87, 95% confidence interval; 0.76~0.97; sensitivity 80.0%, specificity 92.1%).
Conclusions: According to the NCEP-ATP III guidelines, the prevalence of occult CAD on MDCT was significantly higher in the group with a 10% or higher risk for CHD at 10 years. A CACS≥110 was associated with a significantly higher rate of coronary revascularization in asymptomatic patients with significant stenosis on MDCT.
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KEYWORD
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Coronary disease, Tomography, spiral computed, Myocardial revascularization
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