Key result
CAC scoring reclassifies ~52% of elderly intermediate-risk patients into more accurate CHD categories.
Why the study?
Although CAC scoring improves CHD risk prediction, data on its impact on risk classification in clinical practice and empirically derived CAC cutoff values for elderly patients were limited.
Does extending a Framingham refitted risk model with coronary artery calcium (CAC) scoring improve the classification of 10-year hard coronary heart disease risk in asymptomatic elderly participants?
Cohort (n=2,028)
Does extending a Framingham refitted risk model with coronary artery calcium (CAC) scoring improve the classification of 10-year hard coronary heart disease risk in asymptomatic elderly participants?
In asymptomatic elderly patients at intermediate CHD risk, CAC scoring reclassifies 52% of individuals into more accurate risk categories using empirically derived cutoffs of <50 and >615 Agatston units for low and high risk, respectively.
Answers are grounded in this paper and cite their sources.
CAC scoring may reclassify 10-year CHD risk in elderly; leaves open whether derived cut-offs improve outcomes or alter practice.
Objectives The purpose of this study was to examine the effect of coronary artery calcium (CAC) on the classification of 10-year hard coronary heart disease (CHD) risk and to empirically derive cut-off values of the calcium score for a general population of elderly patients. Background Although CAC scoring has been found to improve CHD risk prediction, there are limited data on its impact in clinical practice. Methods The study comprised 2,028 asymptomatic participants (age 69.6 ± 6.2 years) from the Rotterdam Study. During a median follow-up of 9.2 years, 135 hard coronary events occurred. Persons were classified into low (<10%), intermediate (10% to 20%), and high (>20%) 10-year coronary risk categories based on a Framingham refitted risk model. In a second step, the model was extended by CAC, and reclassification percentages were calculated. Cutoff values of CAC for persons in the intermediate-risk category were empirically derived based on 10-year hard CHD risk. Results Reclassification by means of CAC scoring was most substantial in persons initially classified as intermediate risk. In this group, 52% of men and women were reclassified, all into more accurate risk categories. CAC values above 615 or below 50 Agatston units were found appropriate to reclassify persons into high or low risk, respectively. Conclusions In a general population of elderly patients at intermediate CHD risk, CAC scoring is a powerful method to reclassify persons into more appropriate risk categories. Empirically derived CAC cutoff values at which persons at intermediate risk reclassified to either high or low risk were 615 and 50 Agatston units, respectively.
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Elias‐Smale et al. (2010) conducted a cohort in 10-year hard coronary heart disease (CHD) risk in the elderly (n=2,028). Coronary artery calcium (CAC) scoring added to a Framingham refitted risk model vs. Framingham refitted risk model alone was evaluated on Reclassification of 10-year hard coronary heart disease (CHD) risk. Coronary artery calcium scoring reclassified 52% of elderly patients at intermediate 10-year CHD risk into more accurate risk categories (cutoff values >615 for high and <50 for low risk).
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