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Published on: September 22, 2023
Coronary artery calcium and cardiovascular disease prediction by scanner type: the multi-ethnic study of
H S Bhatia1, I C Thomas1, J Denenberg2
1Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
Insights
Coronary artery calcium (CAC) volume and density scores better predict coronary heart disease (CHD) and cardiovascular disease (CVD) events than the Agatston score, irrespective of cardiac computed tomography (CT) scanner type. CAC density shows a strong inverse association with CHD risk.
Area of Science:
- Cardiovascular imaging and risk prediction
- Medical diagnostics and technology assessment
Background:
- Coronary artery calcium (CAC) scoring is crucial for assessing cardiovascular disease (CVD) risk.
- Different cardiac computed tomography (CT) scanner types (electron beam CT [EBCT] and multidetector CT [MDCT]) may influence CAC scoring accuracy.
- Evaluating CAC scoring methods across scanner types is essential for consistent risk prediction.
Purpose of the Study:
- To assess the predictive performance of various coronary artery calcium (CAC) scoring methods.
- To compare these methods across different cardiac computed tomography (CT) scanner types, specifically EBCT and MDCT.
- To determine the optimal CAC scoring method for predicting coronary heart disease (CHD) and CVD events.
Main Methods:
- Analysis of data from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort.
- Measurement of CAC using electron beam CT (EBCT) and multidetector CT (MDCT) in participants without baseline cardiovascular disease (CVD).
- Comparison of Agatston, volume, and density CAC scores using Cox proportional hazards models and area under the curve (AUC) analysis for incident coronary heart disease (CHD) and CVD events.
Main Results:
- The CAC volume and density scores demonstrated superior prediction for CHD and CVD events compared to the Agatston score, across both EBCT and MDCT scanners.
- Hazard ratios for CHD were 1.50 (EBCT) and 1.60 (MDCT) for Agatston score; 2.14 (EBCT) and 1.73 (MDCT) for volume score; and 0.61 (EBCT) and 0.88 (MDCT) for density score.
- The volume and density score model yielded higher AUC values for CHD prediction than the Agatston score, particularly with EBCT.
Conclusions:
- Coronary artery calcium (CAC) volume and density scores offer enhanced risk prediction for coronary heart disease (CHD) and cardiovascular disease (CVD) events, independent of CT scanner type.
- CAC density score shows a significant inverse association with CHD risk.
- Predictive performance for both density and volume scores was stronger with EBCT compared to MDCT.
Aim:
To evaluate the predictive value of coronary artery calcium (CAC) scoring methods across cardiac computed tomography (CT) scanner types.
Materials And Methods:
CAC was measured in participants from the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective cohort study of participants free of baseline cardiovascular disease (CVD), using either EBCT (electron beam CT) or MDCT (multidetector CT). The risks for incident coronary heart disease (CHD) and CVD events were compared for CAC scores per SD using Cox proportional hazards models with multivariable adjustment in 3,362 MESA participants with detectable CAC.
Results:
Using the Agatston score, the hazard ratio (HR) and 95% confidence interval (CI) for CHD was 1.50 (1.27,1.78) for EBCT and 1.60 (1.37,1.87) for MDCT. Using volume and density scores, the HR for CHD was 2.14 (1.71,2.68) for volume and 0.61 (0.48,0.76) for density on EBCT and 1.73 (1.42,2.11) for volume and 0.88 (0.71,1.10) for density on MDCT. Similar results were seen for CVD risk and in analyses stratified by sex, body mass index (BMI), and age. The volume and density score model demonstrated higher areas under the curve (AUC) for CHD than the Agatston score with EBCT (0.702, 95% CI: 0.666,0.738 versus 0.677, 95% CI: 0.638,0.715, p<0.001) and MDCT (0.669, 95% CI: 0.632,0.705 versus 0.660, 95% CI: 0.622,0.697, p=0.216).
Conclusion:
The CAC volume and density scores provide better risk prediction than the Agatston score for CHD and CVD events, regardless of CT scanner type. CAC density was strongly and inversely associated with CHD risk. Both density and volume score prediction were stronger for EBCT than MDCT.
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