Abstract 3297: Combination of Coronary Artery Calcium and Carotid Artery Plaque Scores as a Powerful Negative Predictor for Coronary Artery Disease
Objective: Coronary artery calcium score (CACS) measured by MSCT, carotid plaque score (CPS) measured by carotid ultrasound, and brachial-ankle pulse wave velocity (baPWV) are noninvasive screening tools for coronary artery disease (CAD). However, no studies have compared these modalities within the same population of patients. The aim of this study was to determine which modality is more specific in the presence or absence of CAD.
Methods: CACS, CPS and baPWV were assessed in 80 patients (65 ± 9 years, 51 males) undergoing coronary angiography. ECG-triggered 16-MSCT was used to assess CACS. CPS was defined as the sum of all plaque heights in bilateral carotid arteries. The highest baPWV was used for analysis. Positive CACS, CPS and baPWV cutoff values for detecting CAD were defined as >100, >10 and >16.0m/s, respectively. CAD was defined as a ≥ 50% reduction in diameter in at least one major vessel in coronary angiography. Clinical parameters and the results of each modality were used in a logistic regression model with CAD as the dependent variable.
Result: Of 80 patients, 38 (47.5%) had CAD. Average CACS, CPS and baPWV values were 373.3 ± 684.1, 5.9 ± 4.5, and 16.0 ± 2.9m/s, respectively. CACS was significantly correlated with CPS (r =0.42, p<0.001), whereas there was no correlation between baPWV and CACS or between baPWV and CPS. The sensitivity, specificity, positive predictive value and negative predictive value were, respectively, 73.3%, 78.6%, 76.7% and 75.7% in CACS, 26.3%, 88.1%, 66.7% and 56.9% in CPS, and 47.2%, 53.7%, 47.2% and 53.7% in baPWV. By multivariate logistic regression analysis, CACS was the only strong independent predictor of CAD (OR, 11.0; 95% CI, 3.1 to 38.7; p<0.001). Twenty-three (28.8%) patients had a score of 0 in CACS (CACS=0), 10 (12.5%) in CPS (CPS=0), and 6 (7.5%) in both CACS and CPS. The negative predictive value of a score of 0 in CACS, CPS, and CACS and CPS combined was 82.6%, 80% and 100%, respectively.
Conclusion: CACS outperforms both CPS and baPWV as a noninvasive predictor for CAD. A combined score of 0 in CACS and CPS has a strong negative predictive value for CAD.