Objectives
To evaluate diagnostic yield of coronary artery calcium (CAC) scoring using multidetector CT imaging in rheumatoid
arthritis (RA) patients presented with chest pain.
Patients and methods
Seventy RA patients evaluated using the 28 joint disease activity (DAS-28) score, Disability Index (DI) and radiologically
for Larsen–Dale index. Patients underwent assessment for coronary artery disease (CAD) risk factors and coronary
risk stratification using the Framingham Risk Score (FRS). Patients were clinically categorized according to criteria for
typical anginal pain (TAP) and were scanned using a 64-row spiral CT scanner for CAC scoring and were stratified according
Agatston CAC scores for calculation of total Agatston score (TAS).
Results
Clinically, 32 patients had full criteria of TAP, 27 patients showed a picture of atypical anginal pain, while 11 patients
had non-anginal chest pain. FRS predicted low, intermediate and high risk of CAD in 34, 18 and 18 patients, respectively.
TAS defined no CAC in 4 patients, while mild, moderate and severe CAC was detected in 24, 36 and 6 patients, respectively.
Regression analysis defined low HDL blood level, current smoking and high TAS, DAS-28 and FRS as significant
predictor for TAP in decreasing order of significance. Receiver operating characteristic (ROC) curve analysis defined low
HDL blood level and high TAS as the significant sensitive and specific tests, respectively. There was positive significant
correlation between FRS and both of TAS scores and extent of coronary stenosis. However, FRS was the least significant
predictor for TAP Conclusion
Screening of RA patients with combination of clinical scoring using FRS and CAC using non-invasive multidetector
CT could allow early detection of patients at risk for acute cardiovascular events. However, TAS acts better for the prediction
of TAP. |
