TY - JOUR
T1 - Comparing the pooled cohort equations and coronary artery calcium scores in a symptomatic mixed Asian cohort
AU - Baskaran, Lohendran
AU - Lee, Jing Kai
AU - Ko, Michelle Shi Min
AU - Al’Aref, Subhi J.
AU - Neo, Yu Pei
AU - Ho, Jien Sze
AU - Huang, Weiting
AU - Yoon, Yeonyee Elizabeth
AU - Han, Donghee
AU - Nakanishi, Rine
AU - Tan, Swee Yaw
AU - Al-Mallah, Mouaz
AU - Budoff, Matthew J.
AU - Shaw, Leslee J.
N1 - Funding Information:
This study was supported by the National Medical Research Council (NMRC) of Singapore Centre Grant [Program for Transforming and Evaluating Outcomes in Cardiometabolic disease (PROTECT), Grant number: CG21APR1006], and the National Medical Research Council (NMRC) of Singapore Transitional Award Grant (Improving Obstructive Coronary Artery Disease and Cardiovascular Risk Prediction Using Deep Learning Analysis on Coronary Artery Calcium Imaging, Grant number: TA21nov-0001).
Publisher Copyright:
Copyright © 2023 Baskaran, Lee, Ko, Al’Aref, Neo, Ho, Huang, Yoon, Han, Nakanishi, Tan, Al-Mallah, Budoff and Shaw.
PY - 2023/1/17
Y1 - 2023/1/17
N2 - Background: The value of pooled cohort equations (PCE) as a predictor of major adverse cardiovascular events (MACE) is poorly established among symptomatic patients. Coronary artery calcium (CAC) assessment further improves risk prediction, but non-Western studies are lacking. This study aims to compare PCE and CAC scores within a symptomatic mixed Asian cohort, and to evaluate the incremental value of CAC in predicting MACE, as well as in subgroups based on statin use. Methods: Consecutive patients with stable chest pain who underwent cardiac computed tomography were recruited. Logistic regression was performed to determine the association between risk factors and MACE. Cohort and statin-use subgroup comparisons were done for PCE against Agatston score in predicting MACE. Results: Of 501 patients included, mean (SD) age was 53.7 (10.8) years, mean follow-up period was 4.64 (0.66) years, 43.5% were female, 48.3% used statins, and 50.0% had no CAC. MI occurred in 8 subjects while 9 subjects underwent revascularization. In the general cohort, age, presence of CAC, and ln(Volume) (OR = 1.05, 7.95, and 1.44, respectively) as well as age and PCE score for the CAC = 0 subgroup (OR = 1.16 and 2.24, respectively), were significantly associated with MACE. None of the risk factors were significantly associated with MACE in the CAC > 0 subgroup. Overall, the PCE, Agatston, and their combination obtained an area under the receiver operating characteristic curve (AUC) of 0.501, 0.662, and 0.661, respectively. Separately, the AUC of PCE, Agatston, and their combination for statin non-users were 0.679, 0.753, and 0.734, while that for statin-users were 0.585, 0.615, and 0.631, respectively. Only the performance of PCE alone was statistically significant (p = 0.025) when compared between statin-users (0.507) and non-users (0.783). Conclusion: In a symptomatic mixed Asian cohort, age, presence of CAC, and ln(Volume) were independently associated with MACE for the overall subgroup, age and PCE score for the CAC = 0 subgroup, and no risk factor for the CAC > 0 subgroup. Whilst the PCE performance deteriorated in statin versus non-statin users, the Agatston score performed consistently in both groups.
AB - Background: The value of pooled cohort equations (PCE) as a predictor of major adverse cardiovascular events (MACE) is poorly established among symptomatic patients. Coronary artery calcium (CAC) assessment further improves risk prediction, but non-Western studies are lacking. This study aims to compare PCE and CAC scores within a symptomatic mixed Asian cohort, and to evaluate the incremental value of CAC in predicting MACE, as well as in subgroups based on statin use. Methods: Consecutive patients with stable chest pain who underwent cardiac computed tomography were recruited. Logistic regression was performed to determine the association between risk factors and MACE. Cohort and statin-use subgroup comparisons were done for PCE against Agatston score in predicting MACE. Results: Of 501 patients included, mean (SD) age was 53.7 (10.8) years, mean follow-up period was 4.64 (0.66) years, 43.5% were female, 48.3% used statins, and 50.0% had no CAC. MI occurred in 8 subjects while 9 subjects underwent revascularization. In the general cohort, age, presence of CAC, and ln(Volume) (OR = 1.05, 7.95, and 1.44, respectively) as well as age and PCE score for the CAC = 0 subgroup (OR = 1.16 and 2.24, respectively), were significantly associated with MACE. None of the risk factors were significantly associated with MACE in the CAC > 0 subgroup. Overall, the PCE, Agatston, and their combination obtained an area under the receiver operating characteristic curve (AUC) of 0.501, 0.662, and 0.661, respectively. Separately, the AUC of PCE, Agatston, and their combination for statin non-users were 0.679, 0.753, and 0.734, while that for statin-users were 0.585, 0.615, and 0.631, respectively. Only the performance of PCE alone was statistically significant (p = 0.025) when compared between statin-users (0.507) and non-users (0.783). Conclusion: In a symptomatic mixed Asian cohort, age, presence of CAC, and ln(Volume) were independently associated with MACE for the overall subgroup, age and PCE score for the CAC = 0 subgroup, and no risk factor for the CAC > 0 subgroup. Whilst the PCE performance deteriorated in statin versus non-statin users, the Agatston score performed consistently in both groups.
KW - Agatston score
KW - coronary artery calcium score
KW - major adverse cardiovascular events
KW - pooled cohort equation
KW - predictive model
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U2 - 10.3389/fcvm.2023.1059839
DO - 10.3389/fcvm.2023.1059839
M3 - Article
AN - SCOPUS:85147182083
VL - 10
JO - Frontiers in Cardiovascular Medicine
JF - Frontiers in Cardiovascular Medicine
SN - 2297-055X
M1 - 1059839
ER -