Comparative Prognostic Value of Coronary Calcium Score and Perivascular Fat Attenuation Index in Coronary Artery Disease
Abstract
:1. Introduction
2. Coronary Calcium Score
2.1. Definition
2.2. Measurement
2.3. Prognostic Value
Study/Work | Year | Country | n. Patient | Age | FU | Main Findings | Journal |
---|---|---|---|---|---|---|---|
South Bay Heart Watch [26] | 2004 | USA | 1312 | 65.7 | 8.5 years | CAC score significantly modifies risk prediction in all patients with moderate CV risk | Journal of American Medical Association |
Coronary Artery Calcium Score and Coronary Heart Disease Events in a Large Cohort of Asymptomatic Men and Women [27] | 2005 | Dallas | 16,097 | 53.8 years | 3.5 years | CAC score predicts subclinical atherosclerosis and CAD | American Journal of Epidemiology |
PACC Project [28] | 2005 | Washington | 1983 | 42.8 | 3 years | CAC score to better stratify patients at moderate CV risk | Journal of the American College of Cardiology |
MESA sub-analysis [16] | 2008 | USA | 6722 | 45–84 years | 3.8 years | CAC score in multi-ethnic populations predicts CAD over standard coronary risk factors | New England Journal of Medicine |
All-cause mortality by age and gender based on coronary artery calcium scores [29] | 2016 | USA | 13,092 | 58 ± 11 years | 15 years | CAC score in patients >75 years has a low predictive power of mortality risk for higher rate of non-cardiac death. CAC = 0, regardless of risk factors, correlates with very low long-term mortality | European Heart Journal—Cardiovascular Imaging |
Incidental coronary artery calcification on non-gated CT thorax correlates with risk of cardiovascular events and death [30] | 2022 | England | 717 | 40–70 years | 41.6 months | Incidental CAC correlates short-term CVD and deaths | European Radiology |
Heinz Nixdorf Recall [31] | 2023 | Essen, Germany | 4154 | 20 years | CAC score stratifies in 20 years FU better than assessing CV risk factor, especially in patients initially at intermediate risk | Deutsches Ärzteblatt International |
2.4. Clinical Guidelines
2.5. Limitations
3. Perivascular Fat Attenuation Index
3.1. Definition
3.2. Measurement
3.3. Prognostic Value
3.4. Limitations
4. Comparative Summary
4.1. Clinical Implications
4.2. Limitation
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
References
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CAC Score | Risk Category | Probability of Severe CAD |
---|---|---|
0 | Very low risk | <5% |
1–99 | Mildly increased | 5–10% |
100–299 | Moderately increased | 10–20% |
300–1000 | Moderate to severely increased | 20–40% |
>1000 | Severely increased | >40% |
Role | Details |
---|---|
Risk Stratification | Used in primary prevention, especially in asymptomatic individuals Crucial for intermediate-risk individuals to guide treatment decisions Reclassifies CVD risk upwards or downwards in addition to conventional risk factors |
Impact on Therapy | Low CACs in low ASCVD-risk individuals can reassure clinicians High CACs may prompt a therapy reassessment Not indicated for patients already high ASCVD risk by definition |
Guidelines for Lipid-Lowering Therapy | CACs = 0: possible discontinuation or avoidance of lipid-lowering therapy, unless other risk factors are present CACs = 1–99: consider initiating lipid-lowering therapy, particularly in patients aged 55+ CACs > 100: likely indication for therapy |
Guidelines for Aspirin Therapy | CACs > 100: aspirin may provide a net benefit, especially with scores > 400 CACs = 0: bleeding risk outweighs benefits, suggesting aspirin may not be indicated |
Feature | CAC Score | pFAI |
---|---|---|
Pros | Widely used and accepted in clinical practice | Provides insights into local coronary inflammation |
Simple to measure and interpret | Can detect residual inflammatory coronary risk | |
Strong correlation with incident vascular events | Correlates with CAD independently of CACs, age, gender, risk factors | |
Cons | Does not detect non-calcified plaques | Requires advanced imaging techniques and specialized expertise |
Limited in secondary prevention | Influenced by technical, anatomical, and biological factors | |
Clinical utility still being explored |
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Savo, M.T.; De Amicis, M.; Cozac, D.A.; Cordoni, G.; Corradin, S.; Cozza, E.; Amato, F.; Lassandro, E.; Da Pozzo, S.; Tansella, D.; et al. Comparative Prognostic Value of Coronary Calcium Score and Perivascular Fat Attenuation Index in Coronary Artery Disease. J. Clin. Med. 2024, 13, 5205. https://doi.org/10.3390/jcm13175205
Savo MT, De Amicis M, Cozac DA, Cordoni G, Corradin S, Cozza E, Amato F, Lassandro E, Da Pozzo S, Tansella D, et al. Comparative Prognostic Value of Coronary Calcium Score and Perivascular Fat Attenuation Index in Coronary Artery Disease. Journal of Clinical Medicine. 2024; 13(17):5205. https://doi.org/10.3390/jcm13175205
Chicago/Turabian StyleSavo, Maria Teresa, Morena De Amicis, Dan Alexandru Cozac, Gabriele Cordoni, Simone Corradin, Elena Cozza, Filippo Amato, Eleonora Lassandro, Stefano Da Pozzo, Donatella Tansella, and et al. 2024. "Comparative Prognostic Value of Coronary Calcium Score and Perivascular Fat Attenuation Index in Coronary Artery Disease" Journal of Clinical Medicine 13, no. 17: 5205. https://doi.org/10.3390/jcm13175205