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Published on: September 22, 2023
Coronary calcium coverage score: determination, correlates, and predictive accuracy in the Multi-Ethnic Study of
Elizabeth R Brown1, Richard A Kronmal, David A Bluemke
1Department of Biostatistics, University of Washington, F-600 Health Sciences Bldg, 1705 NE Pacific St, Seattle, WA 98195-7232, USA. elizab@u.washington.edu
Insights
A new calcium coverage score (CCS) predicts coronary heart disease (CHD) events better than traditional scores. This calcified plaque measure identifies individuals at higher risk, aiding in cardiovascular event prediction.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Coronary heart disease (CHD) remains a leading cause of mortality worldwide.
- Accurate risk stratification for CHD is crucial for effective preventive strategies.
- Current methods for assessing coronary artery calcification have limitations in predicting cardiovascular events.
Purpose of the Study:
- To develop and validate a novel calcium score, the Calcium Coverage Score (CCS).
- To quantify the percentage of coronary arteries affected by calcific plaque using unenhanced cardiac computed tomography (CT).
- To correlate CCS with traditional cardiovascular risk factors and predict future cardiovascular events.
Main Methods:
- The study included 3252 participants from the Multi-Ethnic Study of Atherosclerosis with detectable coronary calcification on CT.
- Calcium Coverage Score (CCS) was calculated as the percentage of coronary arteries with calcific plaque.
- Associations with risk factors were analyzed using quasi-Poisson models; associations with outcomes were analyzed using Cox proportional hazards models.
Main Results:
- CCS was significantly associated with hypertension, dyslipidemia, and diabetes (P < .001).
- A twofold increase in CCS was associated with a 52% increased risk of any CHD event (95% CI: 34%, 72%).
- CCS demonstrated superior predictive ability for CHD events compared to Agatston and calcium mass scores, which were not significant predictors when CCS was included.
Conclusions:
- The spatial distribution and extent of calcified plaque, as measured by CCS, are significant contributors to CHD risk.
- CCS offers a valuable tool for enhancing cardiovascular risk assessment beyond traditional measures.
Purpose:
To develop a new calcium score for use with unenhanced cardiac computed tomography (CT) that can be used to define the percentage of coronary arteries affected by calcium and to correlate this score with risk factors and cardiovascular events.
Materials And Methods:
Institutional review boards at all participating centers approved this HIPAA-compliant study, and all participants gave written informed consent. Calcium coverage score (CCS), which represents the percentage of coronary arteries affected by calcific plaque, was calculated for 3252 participants in the Multi-Ethnic Study of Atherosclerosis in whom calcific plaque was detected with CT. Quasi-Poisson models were used to estimate associations (assessed by using t tests with robust standard errors) between CCS and risk factors. Associations between the CCS, Agatston, and calcium mass scores (hereafter, mass scores) and outcomes were estimated and assessed by using Cox proportional hazards models with Wald tests. The predictive ability of these models was assessed by using area under the receiver operating characteristic curves and bootstrap t tests.
Results:
After adjustments were made for age, race, ethnicity, and sex in the quasi-Poisson model, CCS was associated with hypertension, dyslipidemia, and diabetes (P < .001 for all diseases). After adjustments for age and sex, a twofold increase in CCS was associated with a 52% (95% confidence interval: 34%, 72%) increase in risk for any coronary heart disease (CHD) event. When Agatston or mass scores were included with CCS in a Cox model for prediction of CHD events, neither Agatston score nor mass score was a significant predictor, whereas CCS remained significantly associated with CHD events. Although receiver operating characteristic curves suggested that there was a difference between CCS score and Agatston and mass scores in prediction of a cardiac event, no differences in prediction of hard cardiac events (myocardial infarction, death) were found.
Conclusion:
Both spatial distribution and amount of calcified plaque contribute to risk for CHD.
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