Prevalence of coronary artery calcification in a non-specific chest pain population in emergency and cardiology departments compared with the background population: A prospective cohort study in Southern Denmark with 12-month follow-up of cardiac endpoints

Nivethitha Ilangkovan*, Christian Backer Mogensen, Hans Mickley, Annmarie Touborg Lassen, Jess Lambrechtsen, Niels Peter Ronnow Sand, Rasmus Albiniussen, Jørgen Byg, Flemming Hald, Mette Hjortdal Grønhøj, Axel Diederichsen

*Corresponding author for this work

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Abstract

Objectives: To examine and compare the prevalence of coronary artery calcification (CAC) and the frequency of cardiac events in a background population and a cohort of patients with non-specific chest pain (NSCP) who present to an emergency or cardiology department and are discharged without an obvious reason for their symptom. Design: A double-blinded, prospective, observational cohort study that measures both CT-determined CAC scores and cardiac events after 1 year of follow-up. Setting: Emergency and cardiology departments in the Region of Southern Denmark. Subjects: In total, 229 patients with NSCP were compared with 722 patients from a background comparator population. Main outcomes measures: Prevalence of CAC and incidence of unstable angina (UAP), acute myocardial infarction (MI), ventricular tachycardia (VT), coronary revascularisation and cardiac-related mortality 1 year after index contact. Results: There was no significant difference in the prevalence of CAC (OR 0.9 (95% CI 0.6 to 1.3), P=0.546) or the frequency of cardiac endpoints (P=0.64) between the studied groups. When compared with the background population, the OR for patients with NSCP for a CAC >100 Agatston units (AU) was 1.0 (95% CI 0.6 to 1.5), P=0.826. During 1 year of follow-up, two (0.9%) patients with NSCP underwent cardiac revascularisation, while none experienced UAP, MI, VT or death. In the background population, four (0.6%) participants experienced a clinical cardiac endpoint; two had an MI, one had VT and one had a cardiac-related death. Conclusion: The prevalence of CAC (CAC >0 AU) among patients with NSCP is comparable to a background population and there is a low risk of a cardiac event in the first year after discharge. A CAC study does not provide notable clinical utility for risk-stratifying patients with NSCP.

Original languageEnglish
Article numbere018391
JournalBMJ Open
Volume8
Issue number3
Number of pages8
ISSN2044-6055
DOIs
Publication statusPublished - 3. Mar 2018

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Denmark
Hospital Emergency Service
Cohort Studies
Prospective Studies
Population
Emergencies
Outcome Assessment (Health Care)
Incidence

Keywords

  • cardiovascular imaging
  • computed tomography
  • coronary heart disease
  • coronary intervention
  • ischaemic heart disease
  • myocardial infarction
  • Multivariate Analysis
  • Prospective Studies
  • Follow-Up Studies
  • Humans
  • Middle Aged
  • Male
  • Tomography, X-Ray Computed
  • Incidence
  • Vascular Calcification/diagnostic imaging
  • Adult
  • Female
  • Myocardial Infarction/epidemiology
  • Emergency Service, Hospital
  • Double-Blind Method
  • Risk Assessment
  • Comorbidity
  • Tachycardia, Ventricular/epidemiology
  • Logistic Models
  • Cardiac Care Facilities
  • Coronary Artery Disease/diagnostic imaging
  • Denmark/epidemiology
  • Aged
  • Chest Pain/complications
  • Angina, Unstable/epidemiology
  • Coronary Vessels/diagnostic imaging

Cite this

@article{e901487ad54f439589cae63c164835bd,
title = "Prevalence of coronary artery calcification in a non-specific chest pain population in emergency and cardiology departments compared with the background population: A prospective cohort study in Southern Denmark with 12-month follow-up of cardiac endpoints",
abstract = "Objectives: To examine and compare the prevalence of coronary artery calcification (CAC) and the frequency of cardiac events in a background population and a cohort of patients with non-specific chest pain (NSCP) who present to an emergency or cardiology department and are discharged without an obvious reason for their symptom. Design: A double-blinded, prospective, observational cohort study that measures both CT-determined CAC scores and cardiac events after 1 year of follow-up. Setting: Emergency and cardiology departments in the Region of Southern Denmark. Subjects: In total, 229 patients with NSCP were compared with 722 patients from a background comparator population. Main outcomes measures: Prevalence of CAC and incidence of unstable angina (UAP), acute myocardial infarction (MI), ventricular tachycardia (VT), coronary revascularisation and cardiac-related mortality 1 year after index contact. Results: There was no significant difference in the prevalence of CAC (OR 0.9 (95{\%} CI 0.6 to 1.3), P=0.546) or the frequency of cardiac endpoints (P=0.64) between the studied groups. When compared with the background population, the OR for patients with NSCP for a CAC >100 Agatston units (AU) was 1.0 (95{\%} CI 0.6 to 1.5), P=0.826. During 1 year of follow-up, two (0.9{\%}) patients with NSCP underwent cardiac revascularisation, while none experienced UAP, MI, VT or death. In the background population, four (0.6{\%}) participants experienced a clinical cardiac endpoint; two had an MI, one had VT and one had a cardiac-related death. Conclusion: The prevalence of CAC (CAC >0 AU) among patients with NSCP is comparable to a background population and there is a low risk of a cardiac event in the first year after discharge. A CAC study does not provide notable clinical utility for risk-stratifying patients with NSCP.",
keywords = "cardiovascular imaging, computed tomography, coronary heart disease, coronary intervention, ischaemic heart disease, myocardial infarction, Multivariate Analysis, Prospective Studies, Follow-Up Studies, Humans, Middle Aged, Male, Tomography, X-Ray Computed, Incidence, Vascular Calcification/diagnostic imaging, Adult, Female, Myocardial Infarction/epidemiology, Emergency Service, Hospital, Double-Blind Method, Risk Assessment, Comorbidity, Tachycardia, Ventricular/epidemiology, Logistic Models, Cardiac Care Facilities, Coronary Artery Disease/diagnostic imaging, Denmark/epidemiology, Aged, Chest Pain/complications, Angina, Unstable/epidemiology, Coronary Vessels/diagnostic imaging",
author = "Nivethitha Ilangkovan and Mogensen, {Christian Backer} and Hans Mickley and Lassen, {Annmarie Touborg} and Jess Lambrechtsen and Sand, {Niels Peter Ronnow} and Rasmus Albiniussen and J{\o}rgen Byg and Flemming Hald and Gr{\o}nh{\o}j, {Mette Hjortdal} and Axel Diederichsen",
year = "2018",
month = "3",
day = "3",
doi = "10.1136/bmjopen-2017-018391",
language = "English",
volume = "8",
journal = "B M J Open",
issn = "2044-6055",
publisher = "BMJ Group",
number = "3",

}

TY - JOUR

T1 - Prevalence of coronary artery calcification in a non-specific chest pain population in emergency and cardiology departments compared with the background population

T2 - A prospective cohort study in Southern Denmark with 12-month follow-up of cardiac endpoints

AU - Ilangkovan, Nivethitha

AU - Mogensen, Christian Backer

AU - Mickley, Hans

AU - Lassen, Annmarie Touborg

AU - Lambrechtsen, Jess

AU - Sand, Niels Peter Ronnow

AU - Albiniussen, Rasmus

AU - Byg, Jørgen

AU - Hald, Flemming

AU - Grønhøj, Mette Hjortdal

AU - Diederichsen, Axel

PY - 2018/3/3

Y1 - 2018/3/3

N2 - Objectives: To examine and compare the prevalence of coronary artery calcification (CAC) and the frequency of cardiac events in a background population and a cohort of patients with non-specific chest pain (NSCP) who present to an emergency or cardiology department and are discharged without an obvious reason for their symptom. Design: A double-blinded, prospective, observational cohort study that measures both CT-determined CAC scores and cardiac events after 1 year of follow-up. Setting: Emergency and cardiology departments in the Region of Southern Denmark. Subjects: In total, 229 patients with NSCP were compared with 722 patients from a background comparator population. Main outcomes measures: Prevalence of CAC and incidence of unstable angina (UAP), acute myocardial infarction (MI), ventricular tachycardia (VT), coronary revascularisation and cardiac-related mortality 1 year after index contact. Results: There was no significant difference in the prevalence of CAC (OR 0.9 (95% CI 0.6 to 1.3), P=0.546) or the frequency of cardiac endpoints (P=0.64) between the studied groups. When compared with the background population, the OR for patients with NSCP for a CAC >100 Agatston units (AU) was 1.0 (95% CI 0.6 to 1.5), P=0.826. During 1 year of follow-up, two (0.9%) patients with NSCP underwent cardiac revascularisation, while none experienced UAP, MI, VT or death. In the background population, four (0.6%) participants experienced a clinical cardiac endpoint; two had an MI, one had VT and one had a cardiac-related death. Conclusion: The prevalence of CAC (CAC >0 AU) among patients with NSCP is comparable to a background population and there is a low risk of a cardiac event in the first year after discharge. A CAC study does not provide notable clinical utility for risk-stratifying patients with NSCP.

AB - Objectives: To examine and compare the prevalence of coronary artery calcification (CAC) and the frequency of cardiac events in a background population and a cohort of patients with non-specific chest pain (NSCP) who present to an emergency or cardiology department and are discharged without an obvious reason for their symptom. Design: A double-blinded, prospective, observational cohort study that measures both CT-determined CAC scores and cardiac events after 1 year of follow-up. Setting: Emergency and cardiology departments in the Region of Southern Denmark. Subjects: In total, 229 patients with NSCP were compared with 722 patients from a background comparator population. Main outcomes measures: Prevalence of CAC and incidence of unstable angina (UAP), acute myocardial infarction (MI), ventricular tachycardia (VT), coronary revascularisation and cardiac-related mortality 1 year after index contact. Results: There was no significant difference in the prevalence of CAC (OR 0.9 (95% CI 0.6 to 1.3), P=0.546) or the frequency of cardiac endpoints (P=0.64) between the studied groups. When compared with the background population, the OR for patients with NSCP for a CAC >100 Agatston units (AU) was 1.0 (95% CI 0.6 to 1.5), P=0.826. During 1 year of follow-up, two (0.9%) patients with NSCP underwent cardiac revascularisation, while none experienced UAP, MI, VT or death. In the background population, four (0.6%) participants experienced a clinical cardiac endpoint; two had an MI, one had VT and one had a cardiac-related death. Conclusion: The prevalence of CAC (CAC >0 AU) among patients with NSCP is comparable to a background population and there is a low risk of a cardiac event in the first year after discharge. A CAC study does not provide notable clinical utility for risk-stratifying patients with NSCP.

KW - cardiovascular imaging

KW - computed tomography

KW - coronary heart disease

KW - coronary intervention

KW - ischaemic heart disease

KW - myocardial infarction

KW - Multivariate Analysis

KW - Prospective Studies

KW - Follow-Up Studies

KW - Humans

KW - Middle Aged

KW - Male

KW - Tomography, X-Ray Computed

KW - Incidence

KW - Vascular Calcification/diagnostic imaging

KW - Adult

KW - Female

KW - Myocardial Infarction/epidemiology

KW - Emergency Service, Hospital

KW - Double-Blind Method

KW - Risk Assessment

KW - Comorbidity

KW - Tachycardia, Ventricular/epidemiology

KW - Logistic Models

KW - Cardiac Care Facilities

KW - Coronary Artery Disease/diagnostic imaging

KW - Denmark/epidemiology

KW - Aged

KW - Chest Pain/complications

KW - Angina, Unstable/epidemiology

KW - Coronary Vessels/diagnostic imaging

U2 - 10.1136/bmjopen-2017-018391

DO - 10.1136/bmjopen-2017-018391

M3 - Journal article

C2 - 29502085

AN - SCOPUS:85043268363

VL - 8

JO - B M J Open

JF - B M J Open

SN - 2044-6055

IS - 3

M1 - e018391

ER -