Comparison of ct angiography and scoring systems for cardiovascular risk stratification in asymptomatic patients

Objective. To compare the results of CT coronary angiography and risk of cardiovascular complications calculated by using of the most common instruments (scales) in asymptomatic patients. Material and methods. The study included 60 patients (35% men). The cut-off point was data of direct coronary artery imaging using 640-slice CT. In relation to these data, we analyzed distribution of calculated risks of cardiovascular accidents in patients with patent coronary arteries. Risks were determined using the Score, ACC/AHA, Framingham and MESA scales. ROC analysis was applied to assess sensitivity and specificity of these scales, as well as coronary calcium index in identifying severity of coronary artery lesion. Results. Distribution of cardiovascular risks among patients without coronary atherosclerosis showed overestimation of risks when using the SCORE and Framingham scales (+33.33% and +52.38%) and underestimation when using the ACC/AHA and MESA scales (–33.33% and –9.52%). According to ROC analysis, SCORE, Framingham and ACC/AHA scales had no diagnostic value if the cut-off point was the absence of coronary atherosclerosis (p>0.05) and atherosclerotic vascular lesion exceeds 30% (p>0.05). Conclusion. The latest clinical guidelines show that sufficient experience has been accumulated to include CT coronary angiography in routine clinical practice. Our data point to the need for rational use of coronary calcium index, while CT coronary angiography in asymptomatic patients requires prospective studies despite high diagnostic sensitivity.