P1046Coronary calcium score values for risk stratification of coronary artery disease in asymptomatic patients derived from the results of coronary CT angiography

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Purpose:New strategies are needed to evaluate the risk of coronary artery disease(CAD) in asymptomatics.Coronary calcium score(CCS)values could give us information about what patients would be at risk for CAD and would benefit of coronary CT angiography(CCTA).The aim of our study was to establish a coronary calcium value that suggest us to continue with CCTA in a protocol of CAD evaluation in asymptomatics.Methods: Retrospective selection of 232 asymptomatic individuals for CAD,studied with CCTA in a health check up setting.Results:Patients with hypertension, diabetes, smokers and ≥3 classical risk factors for CAD showed a higher value of CCS, 38(16.4%) were in the 75th percentile or higher. CCTA identified 84 individuals(36.2%)without CAD,no significant stenosis in 116(50%) and significant(stenosis>50%) in 32(13.8%). Diabetes, smoking and risk factor association were related with higher percentage of significant stenosis. Stenosis>50% had higher CCS (352.5vs.1,p<0.0001) and with >75th percentil had more percentage of stenosis(57.9%vs.5.2%,p<0.0001). Multivariate analysis found as independent predictors for significant CAD in CCTA: CCS>300(OR 10.9,CI95%3.35-35.8,p=0.0001),percentile>75th(OR=5.65,1.78-17.93;p=0.03) and association of 3 or more classic risk factors (OR=4.19,1.44-12.14,p=0.008).ROC curve analysis reported a better prediction of stenosis with CCS(AUC 0.946) than percentil(0.934) or number of risk factors(0.693).The better cut off for stenosis detection with CCS was 150 (sensitivity 90.6%,specificity 91.5%).Conclusion: In the coronary risk stratification of asymptomatic patients the CCS could be a more powerful tool for the detection of CAD than the classic clinical association of cardiovascular risk factors.CCS>150 seems to be excellent cut off values to continue with CCTA.

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