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Coronary artery calcium score adds little to cardiovascular risk scoring accuracy
Clinical Question
Does adding a coronary artery calcium score to other means of determining risk of cardiovascular disease provide additional benefit?
Bottom line
The CACS, when added to traditional risk assessment for CVD in asymptomatic adults to prevent a CVD event, provides little additional tweaking that results in actionable information. It will move some people calculated to be at high risk into a low-risk category, which may be of slight benefit, but it will also move some low-risk people into a higher risk category. It also comes with costs, including — I didn't know this — radiation exposure that is 17-times higher than a posterior anterior/lateral set of chest x-rays. 1a
Reference
Study design: Meta-analysis (other)
Funding: Government
Setting: Not applicable
Synopsis
The authors of this meta-analysis identified 6 cohort studies (N = 17,961 patients) that assessed the value of adding a coronary artery calcium score (CACS) to a standard cardiovascular disease (CVD) risk equation. These studies were conducted in the United States (3), the Netherlands (1), Germany (1), and South Korea (1). The rates of cardiovascular events in the studies ranged from 0.9% to 9.4%. Two researchers independently screened the studies, extracted the data, and assessed for risk of bias, which was generally low for the included studies. The concordance statistic (C-statistic) assesses the ability of a risk factor, in this case, CACS, to predict outcome. Overall, the risk calculators (such as the Framingham Risk Score) had good, but not great, predictive validity before the CACS was added (C-statistic = 0.693 - 0.80). Adding the CACS only increased the C-statistic an additional 0.036, on average. Although the number of events was small, of the participants classified at low risk by the calculator who were bumped out to a higher risk level by CACS, most (86% to 96%) did not have a CVD event over the subsequent 5 to 10 years. Patients whose high risk by calculation who were downgraded by CACS similarly did not experience a CVD event (91% to 99%) during follow-up. Though not formally studied, CACS determination could carry risks such as cost, incidental findings, radiation exposure, and labeling.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Le risque cardiovasculaire et le”calcium score”
Même le “calcium score” ne semble pas ajouter grand chose à notre capacité de juger le risque cardiovasculaire au delà de ce que le calculateur de Framingham nous donne!
Coronary calcium not significantly useful in quantifying the
Study clearly infers no added advantage in including serum calcium in the battery of investigations in assessing coronary risk in a given individual
Not enough information
There was no comment if perhaps those individuals who were moved to high risk had their RFs more aggressively treated thus lowering risk. Dismayed as I use this score a lot more to convince patients to accept statin therapy when they are reluctant and I feel they are high risk. Also , the radiation from a plain CXR is very low, so I am not sure the 17 x higher amount is significant for a 1 time test. The incidental findings is an issue
Test
test
Coronary artery calcium score
does not add much benefit to the risk assessment of cad