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

Medientyp: E-Artikel
Titel: 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
Beteiligte: Ilangkovan, Nivethitha; Mogensen, Christian Backer; Mickley, Hans; Lassen, Annmarie Touborg; Lambrechtsen, Jess; Sand, Niels Peter Ronnow; Albiniussen, Rasmus; Byg, Jørgen; Hald, Flemming; Grønhøj, Mette Hjortdal; Diederichsen, Axel
Erschienen: BMJ, 2018
Erschienen in: BMJ Open
Umfang: e018391
Sprache: Englisch
DOI: 10.1136/bmjopen-2017-018391
ISSN: 2044-6055
Schlagwörter: General Medicine
Zusammenfassung: <jats:sec><jats:title>Objectives</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>A double-blinded, prospective, observational cohort study that measures both CT-determined CAC scores and cardiac events after 1 year of follow-up.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Emergency and cardiology departments in the Region of Southern Denmark.</jats:p></jats:sec><jats:sec><jats:title>Subjects</jats:title><jats:p>In total, 229 patients with NSCP were compared with 722 patients from a background comparator population.</jats:p></jats:sec><jats:sec><jats:title>Main outcomes measures</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="NCT02422316" ext-link-type="clintrialgov" specific-use="clinicaltrial pre-results">NCT02422316</jats:ext-link>; Pre-results.</jats:p></jats:sec>
Beschreibung: <jats:sec><jats:title>Objectives</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>A double-blinded, prospective, observational cohort study that measures both CT-determined CAC scores and cardiac events after 1 year of follow-up.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Emergency and cardiology departments in the Region of Southern Denmark.</jats:p></jats:sec><jats:sec><jats:title>Subjects</jats:title><jats:p>In total, 229 patients with NSCP were compared with 722 patients from a background comparator population.</jats:p></jats:sec><jats:sec><jats:title>Main outcomes measures</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="NCT02422316" ext-link-type="clintrialgov" specific-use="clinicaltrial pre-results">NCT02422316</jats:ext-link>; Pre-results.</jats:p></jats:sec>
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