Skip to main content
SpringerLink
Log in

Using clinical cardiovascular risk scores to predict coronary artery plaque severity and stenosis detected by CT coronary angiography in asymptomatic Chinese subjects

  • Original paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

We aimed to determine whether the Framingham risk score (FRS), systematic coronary risk evaluation (SCORE), and Chinese multi-provincial cohort study (CMCS) could predict anatomic severity of coronary plaques. From January 2007 to October 2010, we performed a contrast-enhanced 64-slice or 256-slice multidetector computed tomography coronary angiography as part of a health check-up protocol in 806 asymptomatic subjects (70.5% male, 56 ± 9 year-old). Risk scores significantly correlated with calcium volume score, plaque stenosis score and plaque distribution score (P < 0.001). Of the 3 risk scores, the SCORE system showed the best correlation. Overall, 180 (22%) and 37 (5%) subjects were found to have stenosis of 50-69% and more than 70% in at-least one coronary artery segment, respectively. In the prediction of the presence of obstructive CAD (≥50% diameter stenosis), all risk scores had similar discrimination. In the prediction of severe CAD (≥70% diameter stenosis), FRS and CMCS had similar area under curves but SCORE discriminated better than FRS (P < 0.05). The optimal cutoff point to predict obstructive CAD was 9.54% for FRS, 1.05% for CMCS, and 0.95% for SCORE, whereas to predict severe CAD was 9.63, 1.05, 1.15% for FRS, CMCS, SCORE, respectively, with a sensitivity of 0.61–0.70 and a specificity of 0.55–0.66. Cardiovascular risk scores are associated with the severity and extent of coronary artery plaque. The stronger association might translate into a better discrimination using SCORE. These findings will aid in the appropriate selection or recalibration of the risk assessment system for cardiovascular disease screening.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Budoff MJ, Dowe D, Jollis JG, et al (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 52(21):1724–1732

    Google Scholar 

  2. Chao SP, Law WY, Kuo CJ et al (2010) The diagnostic accuracy of 256-row computed tomographic angiography compared with invasive coronary angiography in patients with suspected coronary artery disease. Eur Heart J 31(15):1916–1923

    Article  PubMed  Google Scholar 

  3. Chow BJ, Wells GA, Chen L et al (2010) Prognostic value of 64-slice cardiac computed tomography severity of coronary artery disease, coronary atherosclerosis, and left ventricular ejection fraction. J Am Coll Cardiol 55(10):1017–1028

    Article  PubMed  Google Scholar 

  4. Hadamitzky M, Freissmuth B, Meyer T et al (2009) Prognostic value of coronary computed tomographic angiography for prediction of cardiac events in patients with suspected coronary artery disease. JACC Cardiovasc Imaging 2(4):404–411

    Article  PubMed  Google Scholar 

  5. Wilson PW, D’Agostino RB, Levy D et al (1998) Prediction of coronary heart disease using risk factor categories. Circulation 97(18):1837–1847

    PubMed  CAS  Google Scholar 

  6. Liu J, Hong Y, D’Agostino RB Sr et al (2004) Predictive value for the Chinese population of the Framingham CHD risk assessment tool compared with the Chinese multi-provincial cohort study. JAMA 291(21):2591–2599

    Article  PubMed  CAS  Google Scholar 

  7. Conroy RM, Pyorala K, Fitzgerald AP et al (2003) Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 24(11):987–1003

    Article  PubMed  CAS  Google Scholar 

  8. Johnson KM, Dowe DA, Brink JA (2009) Traditional clinical risk assessment tools do not accurately predict coronary atherosclerotic plaque burden: a CT angiography study. AJR Am J Roentgenol 192(1):235–243

    Article  PubMed  Google Scholar 

  9. Nucifora G, Schuijf JD, van Werkhoven JM et al (2009) Prevalence of coronary artery disease across the Framingham risk categories: coronary artery calcium scoring and MSCT coronary angiography. J Nucl Cardiol 16(3):368–375

    Article  PubMed  Google Scholar 

  10. Grundy SM, Bilheimer D, Chait A et al (1993) Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). JAMA 269(23):3015–3023

    Google Scholar 

  11. Hoffmann U, Moselewski F, Cury RC et al (2004) Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease: patient-versus segment-based analysis. Circulation 110(17):2638–2643

    Article  PubMed  Google Scholar 

  12. Min JK, Shaw LJ, Devereux RB et al (2007) Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol 50(12):1161–1170

    Article  PubMed  Google Scholar 

  13. Russo V, Zavalloni A, Bacchi Reggiani ML et al (2010) Incremental prognostic value of coronary CT angiography in patients with suspected coronary artery disease. Circ Cardiovasc Imaging 3(4):351–359

    Article  PubMed  Google Scholar 

  14. Maffei E, Seitun S, Nieman K, et al (2010) Assessment of coronary artery disease and calcified coronary plaque burden by computed tomography in patients with and without diabetes mellitus. Eur Radiol (in press). doi:10.1007/s00330-00010-01996-z

  15. Jeong HC, Ahn Y, Ko JS et al (2010) The role of 64-slice multi-detector computed tomography in the detection of subclinical atherosclerosis of the coronary artery. Int J Cardiovasc Imaging 26(Suppl 2):253–259

    Article  PubMed  Google Scholar 

  16. Iwasaki K, Matsumoto T, Aono H et al (2011) Prevalence of subclinical atherosclerosis in asymptomatic patients with low-to-intermediate risk by 64-slice computed tomography. Coron Artery Dis 22(1):18–25

    Article  PubMed  Google Scholar 

  17. Kronmal RA, McClelland RL, Detrano R et al (2007) Risk factors for the progression of coronary artery calcification in asymptomatic subjects: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation 115(21):2722–2730

    Article  PubMed  Google Scholar 

  18. Levi F, Lucchini F, Negri E et al (2002) Trends in mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world. Heart 88(2):119–124

    Article  PubMed  CAS  Google Scholar 

  19. van Werkhoven JM, Schuijf JD, Gaemperli O et al (2009) Incremental prognostic value of multi-slice computed tomography coronary angiography over coronary artery calcium scoring in patients with suspected coronary artery disease. Eur Heart J 30(21):2622–2629

    Article  PubMed  Google Scholar 

  20. Min JK, Feignoux J, Treutenaere J et al (2010) The prognostic value of multidetector coronary CT angiography for the prediction of major adverse cardiovascular events: a multicenter observational cohort study. Int J Cardiovasc Imaging 26(6):721–728

    Article  PubMed  Google Scholar 

  21. Maffei E, Seitun S, Martini C et al (2010) CT coronary angiography and exercise ECG in a population with chest pain and low-to-intermediate pre-test likelihood of coronary artery disease. Heart 96(24):1973–1979

    Article  PubMed  Google Scholar 

  22. Stone GW, Maehara A, Lansky AJ et al (2011) A prospective natural-history study of coronary atherosclerosis. N Engl J Med 364(3):226–235

    Article  PubMed  CAS  Google Scholar 

  23. Pundziute G, Schuijf JD, Jukema JW et al (2008) Head-to-head comparison of coronary plaque evaluation between multislice computed tomography and intravascular ultrasound radiofrequency data analysis. JACC Cardiovasc Interv 1(2):176–182

    Article  PubMed  Google Scholar 

  24. Shaw LJ, Raggi P, Schisterman E et al (2003) Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology 228(3):826–833

    Article  PubMed  Google Scholar 

  25. Greenland P, Bonow RO, Brundage BH, et al (2007) ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 49(3):378–402

    Google Scholar 

  26. Raggi P, Callister TQ, Shaw LJ (2004) Progression of coronary artery calcium and risk of first myocardial infarction in patients receiving cholesterol-lowering therapy. Arterioscler Thromb Vasc Biol 24(7):1272–1277

    Article  PubMed  CAS  Google Scholar 

  27. Nissen SE, Tuzcu EM, Schoenhagen P et al (2004) Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. JAMA 291(9):1071–1080

    Article  PubMed  CAS  Google Scholar 

  28. Nissen SE, Nicholls SJ, Sipahi I et al (2006) Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial. JAMA 295(13):1556–1565

    Article  PubMed  CAS  Google Scholar 

  29. Butler J, Shapiro M, Reiber J et al (2007) Extent and distribution of coronary artery disease: a comparative study of invasive versus noninvasive angiography with computed angiography. Am Heart J 153(3):378–384

    Article  PubMed  Google Scholar 

  30. Ugolini P, Pressacco J, Lesperance J et al (2009) Evaluation of coronary atheroma by 64-slice multidetector computed tomography: comparison with intravascular ultrasound and angiography. Can J Cardiol 25(11):641–647

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The study was partly supported by grants from the National Taiwan University Hospital and Department of Health, Taiwan (DOH99-TD-B-111-001). The authors appreciate the cooperation of the participants and also thank the staff of the Health Management Center in National Taiwan University Hospital for their help.

Conflicts of interest

The authors state that there are no conflicts of interest to be disclosed.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, Taiwan

    Bai-Chin Lee, Hsiu-Ching Hsu, Kuo-Liong Chien & Ming-Fong Chen

  2. Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Wen-Jeng Lee & Tiffany Ting-Fang Shih

  3. Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan

    Kuo-Liong Chien

Authors
  1. Bai-Chin Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wen-Jeng Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hsiu-Ching Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kuo-Liong Chien
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tiffany Ting-Fang Shih
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ming-Fong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ming-Fong Chen.

Additional information

The authors Bai-Chin Lee and Wen-Jeng Lee contributed equally to this study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, BC., Lee, WJ., Hsu, HC. et al. Using clinical cardiovascular risk scores to predict coronary artery plaque severity and stenosis detected by CT coronary angiography in asymptomatic Chinese subjects. Int J Cardiovasc Imaging 27, 669–678 (2011). https://doi.org/10.1007/s10554-011-9874-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-011-9874-6

Keywords

Search

Navigation