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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Progression of coronary artery calcium predicts all-cause mortality
Matthew J Budoff1, John E Hokanson, Khurram Nasir
1Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California 90502, USA. mbudoff@labiomed.org
Insights
Coronary artery calcium (CAC) progression predicts all-cause mortality. The square root method best estimates this risk, adding value beyond baseline scores and risk factors for cardiovascular disease assessment.
Area of Science:
- Cardiovascular Imaging and Diagnostics
- Preventive Cardiology
- Medical Informatics
Background:
- Serial assessment of coronary artery calcium (CAC) scores is proposed for tracking coronary artery disease progression.
- Excessive CAC progression may indicate increased future cardiovascular event risk.
- Optimal methods for measuring CAC progression and their prognostic value remain unclear.
Purpose of the Study:
- To evaluate the association between coronary artery calcium (CAC) progression and all-cause mortality in a large cohort.
- To compare three distinct methods for assessing CAC progression and determine which best predicts mortality risk.
Main Methods:
- Analysis of 4,609 asymptomatic individuals undergoing serial CAC measurements via electron beam tomography.
- Comparison of three CAC progression assessment methods: absolute difference, percent annualized difference, and the square root (SQRT) method.
- Statistical modeling to adjust for baseline CAC score, age, sex, and interscan time.
Main Results:
- CAC progression was significantly associated with all-cause mortality across all assessed methods (p < 0.0001).
- The SQRT method demonstrated the strongest predictive value for mortality (HR: 3.34; 95% CI: 2.65-4.21), followed by a >15% yearly increase (HR: 2.98; 95% CI: 2.20-4.95).
- CAC progression did not predict mortality in individuals with a baseline CAC score of 0.
Conclusions:
- Coronary artery calcium (CAC) progression provides incremental prognostic value for all-cause mortality beyond baseline CAC, demographics, and cardiovascular risk factors.
- Serial CAC assessment can be clinically valuable for evaluating plaque progression and future cardiovascular risk.
- The SQRT method is a robust approach for quantifying CAC progression to predict mortality.
Objectives:
This study examined a large cohort to assess whether progression of coronary artery calcium (CAC) was associated with all-cause mortality, and which among 3 different methods to assess CAC progression provided the best estimate of risk.
Background:
Serial assessment of CAC scores has been proposed as a method to follow progression of coronary artery disease, and it has been suggested that excessive CAC progression may be a useful noninvasive predictor of the patient's risk of future events. However, the optimal method to measure calcium progression has not been well established.
Methods:
The study sample consisted of 4,609 consecutive asymptomatic individuals referred by primary physicians for CAC measurement with electron beam tomography, who underwent repeat screening. Three general statistical approaches were taken: 1) the absolute difference between follow-up and baseline CAC score; 2) percent annualized differences between follow-up and baseline CAC score; and 3) difference between square root of baseline and square root of follow-up CAC score >2.5 (the "SQRT method").
Results:
The average interscan time was 3.1 years, and there were 288 deaths. Progression of CAC was significantly associated with mortality regardless of the method used to assess progression (p < 0.0001). After adjusting for baseline score, age, sex, and time between scans, the best CAC progression model to predict mortality was the SQRT method (hazard ratio [HR]: 3.34; 95% confidence interval [CI]: 2.65 to 4.21; p < 0.0001), followed by a >15% yearly increase (HR: 2.98; 95% CI: 2.20 to 4.95; p < 0.0001). Progression was very limited and did not predict mortality in patients with baseline CAC = 0.
Conclusions:
The CAC progression added incremental value in predicting all-cause mortality over baseline score, time between scans, demographics, and cardiovascular risk factors. Serial assessment may have clinical value in assessing plaque progression and future cardiovascular risk.
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