scholarly journals Implications of Gender Difference in Coronary Calcification as Assessed by CT Coronary Angiography

2014 ◽  
Vol 8s4 ◽  
pp. CMC.S18764 ◽  
Author(s):  
Amgad N. Makaryus ◽  
Cristina Sison ◽  
Michelle Kohansieh ◽  
John N. Makaryus
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Calcium Score ◽  
Coronary Calcification ◽  
Smoking History ◽  
Males And Females ◽  
Coronary Events

Background Arterial calcium as measured by 64-slice computed tomography coronary angiography (64-CT) is a reliable predictor of cardiovascular disease risk. Lipid-rich plaques with lower degrees of calcification may pose greater risk for adverse coronary events than more stabilized calcified plaques as a result of the increased risk of plaque rupture, migration, and subsequent acute coronary syndrome. We sought to examine coronary artery calcium scores as measured via 64-CT to assess the extent of calcification and plaque distribution in women compared to men. Methods A total of 138 patients referred for 64-CT were evaluated. Computerized tomographic angiography was performed using the GE LightSpeed VCT. Subgroup analysis comparing male and female data (including demographic data) was performed. All major coronary arteries were analyzed for coronary stenosis/plaque characterization as well as total vessel calcium (Agatston) score quantification. Patient demographics and coronary risk factors were recorded. Results A total of 552 coronary arteries were evaluated in 138 patients (85 men, 53 women). The average age for females was 64.4 ± 10.8 years and for males 60.0 ± 12.8 years. The only demographic/cardiovascular risk factor in which the difference between men and women was significant was smoking history, where 23.5% of men had a history of smoking while only 9.6% of females endorsed having a smoking history ( P < 0.044). On comparison of all total vessel calcium scores, males had a higher total mean calcium score than females in each individual vessel. The results were as follows for males versus females, respectively: left main total vessel calcium score 46.49 versus 16.71 ( P = 0.167); left anterior descending 265.21 versus 109.6 ( P < 0.003); left circumflex 130.5 versus 39.7 ( P < 0.004); and right coronary 213.5 versus 73.8 ( P < 0.01). The odds of having a total calcium score >100 (versus not) was 3.62 times greater in males relative to females, given that all the other cardiovascular risk factors are adjusted for (95% confidence interval: 1.37-9.54). On average, men had an average of 2.1 ± 1.5 epicardial vessels with a calcium score ≥11 compared to 1.3 ± 1.4 for women ( P < 0.005). Conclusion There are clear differences between males and females regarding total vessel calcium scores and therefore risk of future adverse coronary events. Males tended to have higher average calcium scores in each coronary artery than females with a greater tendency to have multiple vessel involvement. Using this information, more large-scale, randomized controlled studies should be performed to correlate differences in the extent of coronary calcification with the observed variance in clinical presentation during coronary events between males and females as a means to potentially establish gender-specific therapeutic regimens.

Sensitivity, specificity of pre-test probability and their use in the relation to syntax score and cardiovascular risk factors

2021 ◽  
Author(s):  
Anh Binh Ho
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Cardiovascular Risk Factors ◽  
European Society ◽  
Syntax Score ◽  
Model Group ◽  
European Society Of Cardiology ◽  
Test Probability

Overview: Coronary angiography is the gold standard for definitive diagnosis of obstructive ischemic coronary disease. However, this is an invasive, expensive test, and may have a number of complications. Models of pre-test probability (PTP) in the guideline of the European Society of Cardiology 2013 and 2019 are easy to use and apply even to doctors who are not cardiologists, and can be implemented at the medical facilities. We aim to assess the sensitivity and specificity of different PTP stratification models follow ESC2013 and 2019; and their use in the relation to SYNTAX score and cardiovascular risk factors. Materials and Methods: Patients (n=108) with chest pain had been treated at Ninh Thuan Provincial Hospital from January 2019 to May 2020. The PTP stratification models were calculated according to the recommendations of the European Society of Cardiology (ESC) 2013 and 2019. Coronary angiography was enrolled for the diagnosis, Quantitative coronary analyzed (QCA) - based stenosis assessment was used with a cut-off of ≥ 50% diameter reduction for significant lesions of coronary artery and SYNTAX score were calculated.Diagnostic accuracy was calculated by usingsensitivity, specificitywhich were analyzed by using statistical software SPSS version 20.0. Results: In the 2013 pre-test probability model,group withmedium PTP andhigh PTPhad the sensitivity of 57.14%, 100% respectively; the overall sensitivity for both groups (the medium and high pre-test) was 59.36%; and the specificity was 58.33%. In the 2019PTP model, group withmedium PTP and high PTP had the sensitivity of 41.67%, of 67.57% respectively;the overall sensitivity for both groups (the medium and high scores PTP) was 61.22%; and the specificity was 80%. The group of low SYNTAXscore (<23) had at most 93 cases, accounting for 86.1%; the lowest was the group of high SYNTAX score (≥ 33 points) accounting for 2.8%. There were statistically significant differences in patients with and without smoking, history of hypertension for both PTP model 2013 and 2019. Conclusion: Sensitivity and specificity of the 2013 and 2019 PTP were quite high in the relation to the severity of coronary artery which were evaluated by SYNTAX score.

scholarly journals Association of Lipoprotein-Associated Phospholipase A2 with Coronary Artery Disease in African-Americans and Caucasians

2010 ◽  
Vol 95 (5) ◽  
pp. 2376-2383 ◽  
Author(s):  
Erdembileg Anuurad ◽  
Zeynep Ozturk ◽  
Byambaa Enkhmaa ◽  
Thomas A. Pearson ◽  
Lars Berglund
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
African American ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
African Americans ◽  
Coronary Angiography ◽  
Pla2 Activity ◽  
Artery Disease

Abstract Context: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is bound predominately to low-density lipoprotein and has been implicated as a risk factor for coronary artery disease (CAD). Objective: We investigated the association between Lp-PLA2 and CAD in a biethnic African-American and Caucasian population. Design: Lp-PLA2 mass, activity, and index, an integrated measure of mass and activity, and other cardiovascular risk factors were determined in 224 African-Americans and 336 Caucasians undergoing coronary angiography. Main Outcome Measures: We assessed the distribution of Lp-PLA2 levels and determined the predictive role of Lp-PLA2 as a risk factor for CAD. Results: Levels of Lp-PLA2 mass and activity were higher among Caucasians compared with African-Americans (293 ± 75 vs. 232 ± 76 ng/ml, P &lt; 0.001 for mass and 173 ± 41 vs. 141 ± 39 nmol/min/ml, P &lt; 0.001 for activity, respectively). However, Lp-PLA2 index was similar in the two groups (0.61 ± 0.17 vs. 0.64 ± 0.19, P = NS). In both ethnic groups, Lp-PLA2 activity and index was significantly higher among subjects with CAD. African-American subjects with CAD had significantly higher Lp-PLA2 index than corresponding Caucasian subjects (0.69 ± 0.20 vs. 0.63 ± 0.18, P = 0.028). In multivariate regression analyses, after adjusting for other risk factors, Lp-PLA2 index was independently (odds ratio 6.7, P = 0.047) associated with CAD in African-Americans but not Caucasians. Conclusions: Lp-PLA2 activity and index was associated with presence of CAD among African-Americans and Caucasians undergoing coronary angiography. The findings suggest an independent impact of vascular inflammation among African-Americans as contributory to CAD risk and underscore the importance of Lp-PLA2 as a cardiovascular risk factor.

scholarly journals Peculiarities and Consequences of Different Angiographic Patterns of STEMI Patients Receiving Coronary Angiography Only: Data from a Large Primary PCI Registry

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Alexandru Burlacu ◽  
Grigore Tinica ◽  
Bogdan Artene ◽  
Paul Simion ◽  
Diana Savuc ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Coronary Angiography ◽  
Cardiovascular Risk Factors ◽  
Coronary Arteries ◽  
Univariate Analysis ◽  
Diagnostic Errors ◽  
High Volume ◽  
Process Efficiency ◽  
Primary Pci

Background. Inappropriate cardiac catheterization lab activation together with false-positive angiographies and no-culprit found coronary interventions are now reported as costly to the medical system, influencing STEMI process efficiency. We aimed to analyze data from a high-volume interventional centre (>1000 primary PCIs/year) exploring etiologies and reporting characteristics from all “blank” coronary angiographies in STEMI. Methods. In this retrospective observational single-centre cohort study, we reported two-year data from a primary PCI registry (2035 patients). “Angio-only” cases were assigned to one of these categories: (a) Takotsubo syndrome; (b) coronary embolisation; (c) myocardial infarction with nonobstructive coronary arteries; (d) myocarditis; (e) CABG-referred; (f) normal coronary arteries (mostly diagnostic errors); and (g)others (refusals and death prior angioplasty). Univariate analysis assessed correlations between each category and cardiovascular risk factors. Results. 412 STEMI patients received coronary angiography “only,” accounting for 20.2% of cath lab activations. Barely 77 patients had diagnostic errors (3.8% from all patients) implying false-activations. 40% of “angio-only” patients (n = 165) were referred to surgery due to severe atherosclerosis or mechanical complications. Patients with diagnostic errors and normal arteries displayed strong correlations with all cardiovascular risk factors. Probably, numerous risk factors “convinced” emergency department staff to call for an angio. Conclusions. STEMI network professionals often confront with coronary angiography “only” situations. We propose a classification according to etiologies. Next, STEMI guidelines should include audit recommendations and specific thresholds regarding “angio-only” patients, with specific focus on MINOCA, CABG referrals, and diagnostic errors. These measures will have a double impact: a better management of the patient, and a clearer perception about the usefulness of the investments.

Performance of coronary calcium score and epicardial fat volume in early diagnostic of coronary artery disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Agoston Coldea ◽  
A Zlibut ◽  
C Cionca ◽  
I Muresan ◽  
D Horvat ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Calcium Score ◽  
Coronary Calcium ◽  
Coronary Calcium Score ◽  
Epicardial Fat Volume ◽  
Artery Disease ◽  
Fat Volume

Abstract Background Coronary artery disease (CAD) remains a world leading cause of death, despite the development of traditional risk scores based on the quantification of cardiovascular risk factors. Coronary calcium score (CCS) determined by cardiac computed tomography (CCT) is a noninvasive tool with major implications in early diagnosis and in outcome prediction in CAD patients. Epicardial fat volume (EFV) is a recently described CCT-based diagnostic and prognostic tool of CAD and outcome. Purpose This study sought to investigate the performance of coronary calcium score and EFV in early diagnosing CAD. Methods We conducted a prospective, single-center, cross-sectional study on patients suspected of CAD. All patients were submitted to detailed clinical data, 12-lead electrocardiogram, estimating pretest probability, stress test, echocardiography, CCT imaging. In the study subjects was assessed CCS, EFV and the number of calcified plaques (NoP). The total CCS load was then ranked in the following scoring groups: 0 (no evidence of coronary calcium; reference group), 1–99 (minimal to mild), 100–399 (moderate), and 400–999 (extensive) and ≥1000 (very extensive). The subjects in the study were classified according to the NoP derived from their CCS scans (no plaques, 1–5, 6–10 and more than 10 calcified plaques). CAD was defined as coronary stenosis over 50% of the vessel. Results Among 540 patients (55.8±11.2 years of age; 52% women) met the enrollment criteria, 98 patients presented CAD. Spearman correlation analysis revealed strong correlations between EFV index and CCS (r=0.45; p&lt;0.0001) and between EFV index and NoP (r=0.44; p&lt;0.0001), after adjustment for age, sex, body mass index, hypertension, diabetes and low-density lipoprotein cholesterol. The area under the curve of the receiver-operator curve for CAD prediction by CCS &gt;70.3 UH (cut-off value) was significantly higher (AUC=0.927; p&lt;0.0001) by comparison with EFV index &gt;40.8 ml/m2 (AUC=0.816; p&lt;0.0001) and NoP &gt;4 (AUC=0.928; p&lt;0.0001). The association of all three parameter, CCS, EFV and NoP, increases the prediction power of CAD, providing an AUC of 0.969 with a 0.70 sensibility and 0.95 specificity. Conclusion The combined use of EPV, CCS and NoP has a very high predictive capacity for CAD, regardless of the classic cardiovascular risk factors. This increases the diagnostic capacity of CAD beyond every parameter used alone. Funding Acknowledgement Type of funding source: None

Abstract 1528: Gender Differences In The Effect Of Traditional Cardiac Risk Factors On Age At Presentation With Stemi

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
William Herzog ◽  
Thomas Aversano
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Family History ◽  
Female Gender ◽  
Smoking History ◽  
Men And Women ◽  
History Of ◽  
Males And Females ◽  
Artery Disease

For coronary artery disease (CAD), female gender is ’protective’, so that women typically present with clinically apparent CAD a decade later than men. We examined the extent to which traditional cardiovascular risk factor influence the age at presentation with STEMI in men and women. The Cardiovascular Patient Outcomes Research Team (C-PORT) primary PCI registry includes 7197 patients (5070 males and 2109 females) who presented with STEMI at 33 participating hospitals. The table below depicts the average age at presentation with STEMI in males and females with and without diabetes, hypercholesterolemia, hypertension, a family history of coronary artery disease and smoking history (current or former). The effect of smoking, family history and hypertension on age at presentation remained significant in multivariate analysis in both men and women. In both males and females, a family history of CAD and a positive smoking history are associated with presentation with STEMI at a younger age. Both have a greater effect in females. This is particularly true of smoking with lowers the age of presentation by 9 years in women, compared with 3.8 years in men. Male and female patients with a history of hypertension are older at presentation with STEMI, perhaps because the anti-ischemic effects of anti-hypertensive medications. We conclude that while the effect of most traditional risk factors for CAD on age at presentation with STEMI are similar in men and women, smoking lowers the age at presentation to a much greater degree in women. In women who do not smoke, STEMI is delayed for a decade or more compared to men; for women who do, the protective effect of female gender is nearly obliterated.

Abstract 18550: Association Between a Healthy Cardiovascular Risk Factors Profile and Coronary Artery Calcium Score: Results From the Brazilian Longitudinal Study of Adults Health (ELSA-Brasil)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Isabela M Bensenor ◽  
Alessandra C Goulart ◽  
Itamar S Santos ◽  
Dora Chor ◽  
Alexandre C Pereira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Longitudinal Study ◽  
Coronary Artery ◽  
Cardiovascular Risk Factors ◽  
Coronary Artery Calcium ◽  
Task Force ◽  
Coronary Artery Calcium Score ◽  
Subclinical Atherosclerosis ◽  
Calcium Score

Introduction: Few studies evaluated the relationship between a favorable lifestyle a healthy profile of cardiovascular risk factors and subclinical atherosclerosis measured by Coronary Artery Calcium Score (CAC). Hypothesis: to identify the association between lifestyle profile and CAC among mid-elderly men and women. Methods: We included 4058 participants of the Brazilian Longitudinal Study of Health aged 35-74 years who underwent CAC measurement. The 2010 Task Force of the American Heart Association cut-offs were used to define the ideal profile and included smoking, physical activity, diet, blood pressure, glucose/cholesterol levels, and body-mass index. Only 21 participants had at least 6 ideal metrics. Participants were categorized according the number of ideal risk factors (IRF): 0-1 (n=1152, 28.4%), 2 (n=1234, 30.4%), 3-4 (n=1489, 36.7%), or 5-7 (n=183, 4.5%). (Figure 1). Results: Compared to individuals with 0-1 IRF, the odds ratio (OR) of participants with 2 IRF presenting with CAC of 0 (compared to >0), <100 (compared to ≥100), and <400 (compared to ≥400) was 0.65 (95% confidence interval [CI]: 0.54-0.79), 0.59 (95%CI: 0.45-0.77), and 0.61 (95%CI: 0.39-0.94), respectively. Similarly, the ORs of CACs of 0, <100, and <400 in individuals with 3-4 IRF were 0.54 (95%CI: 0.44-0.66), 0.42 (95%CI: 0.31-0.57), and 0.56 (95%CI: 0.34-0.92), respectively. The ORs of CACs of 0, <100, and <400 in individuals with 5-7 IRF were 0.33 (95%CI: 018-0.58), 0.17 (95%CI: 0.04-0.72), and zero, respectively. Conclusion: Subjects with more IRF had lower CAC compared to subjects with lower ICH metrics, but CAC >0 was found even in these individuals.

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