Abstract 2595: Coronary Artery Imaging Using Multislice Computed Tomography Provides Risk Stratification in Addition to Framingham Risk Score
Purpose: In primary prevention, the Framingham risk score (FRS) predicts 10-year coronary artery disease (CAD) mortality. Most acute coronary events occur in association with proximal nonobstructive atherosclerotic plaques (AP), which are often not detected by luminography or stress testing. Multislice computed tomography (MSCT) detects both obstructive CAD and proximal AP with high accuracy. We sought to assess the association of FRS with obstructive CAD and proximal AP.
Methods: Coronary MSCT (40- or 64-slice) was performed on 295 individuals (61% men, mean age 54±13 years) without documented CAD, referred for coronary evaluation. FRS was computed and subjects were stratified according to 10-year risk (72% low, 25% intermediate and 3% high). Obstructive CAD was defined as >= 50% stenosis in >= 1-epicardial coronary artery. Proximal AP was defined as presence of calcified or noncalcified plaque in the left main or proximal left anterior descending arteries.
Results: Increasing tertile of 10-year FRS was associated with obstructive CAD (p < 0.001) and proximal AP (p < 0.001, Figure⇓). In low and intermediate FRS groups, proximal AP was detected at greater than twice the frequency of obstructive CAD (75% vs. 34% for intermediate FRS, 44% vs. 16% for low FRS, both p < 0.01).
Conclusions: There is a strong positive association between FRS and proximal AP or obstructive CAD. However, proximal AP is detected with higher frequency than obstructive CAD. Incremental ability of MSCT to identify proximal AP in low and intermediate FRS groups provides the potential for better risk stratification and may lead to better targeted and more effective primary prevention strategies.