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Background: Based on the 2013 ACC/AHA Guidelines on the Assessment of Cardiovascular Risk, expert opinion recommends revising a patient's risk assessment upward when they have either a CAC score ≥ 300 Agatston units or a Multi-Ethnic Study of Atherosclerosis (MESA) percentile ≥ 75%. Data has shown that African-American patients tend to have lower calcium scores than their white counterparts. This study looks at whether the ACC/AHA guidelines can be applied uniformly across different races.
Methods: Single center coronary CT angiography studies were reviewed from 2013-2014 in patients presenting to the emergency department with chest pain. From the CT angiography report, CAC scores, MESA percentiles, and percentage of stenosis of the major coronary arteries were recorded for patients who had a CAC score greater than 0. Demographic information was obtained from the electronic medical record.
Results: Data from 156 white patients and 37 black patients were analyzed. White patients had a higher average CAC score of 417.55, as opposed to 150.03 for black patients (p = 0.01). The odds ratio for a white patient having a CAC of 300 or more compared to a black patient was 3.58 (95CI 1.32-9.72, p = 0.01). The odds ratio for a white patient having a MESA percentile over 75% compared to a black patient was 2.18 (95CI 1.04-4.56, p = 0.03).
Conclusions: Our data found that black patients who presented to the emergency room with chest pain had lower average calcium scores and were less likely to have a CAC score ≥ 300 or MESA percentile ≥ 75% than white patients of the same age, gender and risk profile. Considering that black patients generally tend to be higher risk for CAD, and that a significant number of black patients are falling short of the ACC/AHA thresholds, there is a chance that the guidelines may be underestimating the risk of these patients who may require further testing, such as a stress test or coronary angiogram. Further studies are needed to assess long-term outcomes and whether the CAC guidelines should be adjusted downward for black patients.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Innovations in Cardiovascular Risk Assessment and Reduction
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1235-060
- 2017 American College of Cardiology Foundation