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All-cause mortality in asymptomatic persons with extensive Agatston scores above 1000

Jaideep Patel1, Michael J Blaha2, John W McEvoy2

  • 1Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Division of Internal Medicine, Virginia Commonwealth University Medical Center-Medical College of Virginia, 1200 E Broad Street, Richmond, VA 23298, USA.

Journal of Cardiovascular Computed Tomography
|March 4, 2014
PubMed

Insights

Extensive coronary calcified plaque, measured by Agatston score, is linked to a continuous increase in mortality risk. Even very high Agatston scores over 1000 show no upper limit for this increased risk.

Area of Science:

  • Cardiovascular Medicine
  • Radiology
  • Preventive Cardiology

Background:

  • Risk stratification for patients with extensive coronary calcified plaque has been challenging due to limited data.
  • The Agatston score quantifies coronary artery calcium (CAC) and is a marker of atherosclerosis.

Purpose of the Study:

  • To evaluate all-cause mortality rates in asymptomatic individuals with markedly elevated Agatston scores (>1000).
  • To determine if there is an upper threshold for mortality risk associated with very high CAC levels.

Main Methods:

  • A large cohort of 44,052 asymptomatic patients undergoing coronary calcium scans was analyzed.
  • All-cause mortality was assessed over a mean follow-up of 5.6 years, stratified by Agatston score categories.
  • Multivariable Cox regression and post-estimation modeling were used to analyze mortality risk and identify potential risk thresholds.

Main Results:

  • A continuous, graded decrease in survival was observed with increasing Agatston scores, extending beyond 1000.
  • Patients with Agatston scores >1000 showed significantly higher mortality risk (8- to 13-fold) compared to those with a score of 0.
  • Mortality risk increased substantially for Agatston scores >2000, with no evidence of an upper risk threshold.

Conclusions:

  • Elevated coronary calcified plaque, indicated by high Agatston scores, is associated with a progressively worsening survival.
  • The findings suggest that there is no ceiling to the increased mortality risk posed by extensive coronary calcification.
Abstract

Keywords:
Agatston score > 1000Calcified plaque in coronary arteries paradoxCoronary artery calciumStable plaque

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