Abstract 17726: Coronary Artery Calcium Score is the Strongest Predictor of the Extent of Coronary Artery Disease in Asymptomatic Subjects at Risk

Abstract

Background: Framingham risk score (FRS), Coronary artery calcium score (CACS), carotid intima-medial thickness (IMT), and ankle-brachial index (ABI) have been used as predictors of subclinical coronary artery disease (CAD). The modified Duke score (MDS) is a score of coronary disease severity derived from coronary CT angiography (CCTA). There are few studies that compare the value of the above screening tools predicting the extent of obstructive CAD as identified by CCTA in asymptomatic patients.

Methods: 374 asymptomatic patients with subclinical atherosclerosis from the High Risk Plaque study were evaluated using CCTA. Using a 16 segment convention for the coronary tree, MDS was calculated (high MDS defined as ≥3) and CACS, IMT, Framingham risk score (high defined as ≥20% cardiovascular risk), plasma triglycerides, cholesterol, LDL, HDL were measured for each patient.

Results: Patients with high MDS (n=58) were more likely male (81.03% vs 54.86%, p<0.001), older (>70 years 50% vs 31.66%, p=0.01), had lower HDL (46.12±9.61 vs 55.67±15.63, p<0.001), higher triglycerides (188.77±132.46 vs. 150.98±74.47, p=0.002), higher FRS (27.59% vs 11.60%, p<0.001), higher IMT (0.82±0.13 vs 0.77 ±0.17, p<0.05) and higher CACS (67.24% vs 15.05%, p<0.001) compared to patients with low MDS. In multivariable analysis, important predictors of high MDS were CACS (OR 11.588, p<0.001), IMT (OR 4.849, p<0.05), FRS (OR 2.182, p<0.001) low HDL (OR 3.127, p<0.001) but not ABI, triglycerides, LDL and total cholesterol. Results of AUC analysis are shown in figure.

Conclusion: Compared with other measures of subclinical atherosclerosis CACS has the strongest association with obstructive CAD as identified by the CCTA modified Duke Score.