心血管疾患と診断

Coronary Artery Calcium and Arterial Stiffness Values that are Predictive of Long-Term Cardiovascular Events in People with Stable Coronary Artery Disease

Abstract

Sukit Yamwong

Introduction: Major adverse cardiovascular events (MACEs) have been linked to subclinical atherosclerosis, which can be identified by elevated coronary artery calcium (CAC) or arterial stiffness as measured by the cardio-ankle vascular index (CAVI). However, there aren't many comparable data from these two assessments on the same population.

Methods: From 2005 to 2013, both asymptomatic and symptomatic patients with stable coronary artery disease (CAD) who underwent coronary computed tomography and CAVI were enrolled and followed until December 2019 for the occurrence of MACEs (cardiovascular [CV] death, nonfatal myocardial infarction [MI], and nonfatal stroke). The relationships between the CAC score and CAVI and long-term MACEs were evaluated using a cause-specific hazard model.

Results: 8687 patients participated in all. In 49.7%, 31.9%, 12.3%, and 6.1% of them, the CAC scores were 0–99, 100–399, and 400, respectively. In 23.8%, 36.3%, 44.5%, and 56.2% of cases, arterial stiffness (CAVI 9.0) was linked to the severity of CAC. MACEs occurred in 8.0% of patients over an average of 9.9. 2.4 years of follow-up (95 percent CI: 7.4 to 8.6 percent) of subjects. CAC scores of 100–399 and CAVI scores of 9.0 were found to independently predict the occurrence of MACEs with hazard ratios (95% CI) of 1.70 (1.13–1.98), 1.87 (1.33–2.63), and 1.27 (1.06–1.52), respectively, after adjusting for covariables. Hypertension, diabetes mellitus (DM), chronic kidney disease (CKD), aspirin, and statin therapy were additional risk factors.

Conclusion: Both asymptomatic and symptomatic patients with stable CAD are more likely to experience MACEs in the long run if they have a CAC score below 100 or a CAVI score below 9.0. These two non-invasive tests can be used to screen for and direct treatment to prevent CV events in the future.