Aortic valve and aortic root calcifications for predicting major adverse cardiovascular events: NADESICO study

To assess aortic valve calcification (AVC) and aortic root calcification (ARC) and to examine their usefulness for predicting major adverse cardiovascular events (MACE). This multicenter prospective cohort study recruited 1187 patients suspected of coronary artery disease (CAD) who underwent coronary computed tomography. MACE included cardiovascular death, myocardial infarction, stroke, revascularization and hospitalization for unstable angina, heart failure or aortic disease. Cox proportional hazard model and C-statistic were used to assess mutual associations between Framingham risk score, coronary artery calcification (CAC) and AVC or ARC with incident MACE. A total of 980 patients (mean age, 65 ± 7 years; female, 45.8%) with assessment of AVC and ARC Agatston scores were analyzed. Among them, 86 developed MACE during a median follow-up of 4.04 years. Cox proportional hazard analyses showed that the presence or severity of AVC and ARC was significantly associated with MACE development after adjusting the CAC Agatston score. Compared with the model of Framingham risk score alone, C-statistics of the model adding AVC or ARC Agatston score to Framingham risk score increased (ΔC-statistic; + 0.013 or + 0.032, respectively). However, they were not superior to the model adding CAC Agatston (ΔC-statistic; - 0.077 and - 0.058, respectively). AVC or ARC on the top of CAC was a predictive factor for increased MACE in patients with suspected CAD. However, an additional model of AVC or ARC score to Framingham risk score was not as effective as that of CAC Agatston score.