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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Racial and ethnic differences in severity of coronary calcification among patients undergoing PCI: Results from a
Solomon W Bienstock1, Rajeev Samtani1, Ashton C Lai1
1Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Insights
Hispanic patients undergoing percutaneous coronary intervention (PCI) had lower coronary artery calcium (CAC) scores than non-Hispanic patients, despite higher risk factors. This suggests current CAC scoring may underestimate risk in Hispanic populations.
Area of Science:
- Cardiology
- Public Health
- Health Disparities
Background:
- Racial disparities in coronary artery calcium (CAC) burden are known in population studies.
- Associations between race/ethnicity and CAC in percutaneous coronary intervention (PCI) cohorts are not well understood.
Purpose of the Study:
- To investigate the relationship between race/ethnicity and CAC burden in patients undergoing PCI.
- To determine if existing CAC scoring accurately reflects risk across different racial/ethnic groups in a PCI population.
Main Methods:
- Retrospective analysis of 1025 patients who underwent PCI between 2012 and 2020.
- Patients categorized as non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic (H).
- Negative binomial regression used to analyze associations between race/ethnicity and CAC scores, adjusting for clinical factors.
Main Results:
- Median CAC scores varied significantly by race/ethnicity: NHW (760), NHB (500), and H (462).
- Hispanic patients had a higher prevalence of diabetes, hypertension, and hyperlipidemia.
- Adjusted analysis revealed significantly lower CAC in Hispanic patients compared to NHW (β = -324.1, p < 0.0001), while no significant difference was found for NHB patients.
Conclusions:
- Hispanic patients undergoing PCI exhibit lower CAC burden despite a higher clinical risk profile.
- Standardized CAC scoring may underestimate cardiovascular risk in the Hispanic population.
- Developing race/ethnicity-specific CAC thresholds could improve risk stratification and clinical decision-making.
Background:
Although population-based studies have demonstrated racial heterogeneity in coronary artery calcium (CAC) burden, the degree to which such associations extend to percutaneous coronary intervention (PCI) cohorts remains poorly characterized. We sought to evaluate the associations between race/ethnicity and CAC in a PCI population.
Methods:
This single center retrospective study analyzed 1025 patients with prior CAC who underwent PCI between January 1, 2012 and May 15, 2020. Patients were grouped as non-Hispanic White (NHW, N = 779), non-Hispanic Black (NHB, N = 81) and Hispanic (H, N = 165). Associations between race and CAC (Agatston units) were examined using negative binomial regression while adjusting for baseline parameters.
Results:
Among the 1025 patients (mean age 65.8, 70% male) who underwent PCI, NHW, NHB, and H populations had median CAC scores of 760, 500, and 462 Agatston units, respectively (p < 0.0001). Hispanic patients displayed a higher burden of diabetes mellitus, hypertension and hyperlipidemia compared with other groups. After adjusting for baseline differences and compared with NHW, the inverse association between Hispanic and CAC persisted (β = -324.1, p < 0.0001) whereas differences were not significant for NHB (β = -51.5, p = 0.67).
Conclusions:
Despite a higher risk clinical phenotype, Hispanic patients who underwent PCI had significantly lower CAC compared with non-Hispanic patients. Thus, current risk stratification models using universalized CAC scores may underestimate the risk for the Hispanic population. Race/ethnicity-informed CAC thresholds may better guide clinical decisions.
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