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Updated: Aug 1, 2025
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary artery calcium progression and all-cause mortality
Bibinaz Eghtedari1, April Kinninger, Sion K Roy
1Division of Cardiology, Department of Internal Medicine, The Lundquist Institute, Harbor-University of California-Los Angeles, Torrance, California, USA.
Insights
Coronary artery calcium (CAC) progression over 20 units annually strongly predicts all-cause mortality. This finding aids in identifying high-risk individuals for closer monitoring and proactive treatment strategies.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Coronary artery calcium (CAC) is a noninvasive marker for atherosclerotic burden and cardiovascular event risk.
- Previous studies indicated CAC progression predicts all-cause mortality, but quantification was needed.
Purpose of the Study:
- To quantify the association between annualized CAC progression and all-cause mortality.
- To identify a specific threshold of CAC progression indicative of increased mortality risk.
Main Methods:
- A cohort of 3260 individuals (aged 30-89) with initial and follow-up CAC scans (≥12 months apart) were analyzed.
- Receiver operator characteristic (ROC) curves determined the optimal CAC progression threshold for mortality prediction.
- Cox proportional hazards models assessed the association between annualized CAC progression and mortality, adjusting for cardiovascular risk factors.
Main Results:
- The average follow-up period was 4.7 years between scans and 9.1 years overall.
- An annualized CAC progression of 20 units demonstrated optimal sensitivity (58%) and specificity (82%) in ROC analysis.
- Annualized CAC progression >20 units was significantly associated with all-cause mortality (HR 1.84, 95% CI 1.28-2.64, P=0.001) after multivariate adjustment.
Conclusions:
- Annualized CAC progression exceeding 20 units per year is a significant predictor of all-cause mortality.
- This metric can enhance clinical decision-making for patient surveillance and treatment intensity.
Background:
Coronary artery calcium (CAC) has been demonstrated as a noninvasive, low-cost means of assessing atherosclerotic burden and risk of major cardiovascular events. While it has been previously shown that CAC progression predicts all-cause mortality, we sought to quantify this association by examining a large cohort over a follow-up period of 1-22 years.
Methods:
We studied 3260 persons aged 30-89 years referred by their primary physician for CAC measurement, with a follow-up scan at least 12 months from the initial scan. Receiver operator characteristic (ROC) curves assessed a level of annualized CAC progression that predicted all-cause mortality. Multivariate analyses using Cox proportional hazards models were used to compute hazard ratios and 95% confidence intervals (CIs) for the association between annualized CAC progression and death after adjusting for relevant cardiovascular risk factors.
Results:
The average time between scans was 4.7 ± 3.2 years with an additional average of 9.1 ± 4.0 years of follow-up time. The average age of the cohort was 58.1 ± 10.5 years, 70% being male, and 164 deaths occurred. Annualized CAC progression of 20 units optimized sensitivity (58%) and specificity (82%) in ROC curve analysis. Annualized CAC progression of 20 units was significantly associated with mortality while adjusting for age, sex, race, diabetes, hypertension, hyperlipidemia, smoking, baseline CAC level, family history, and time between scans, hazard ratio 1.84 (95% CI, 1.28-2.64) P = 0.001.
Conclusion:
Annualized CAC progression of greater than 20 units per year significantly predicts all-cause mortality. This may add clinical value in encouraging close surveillance and aggressive treatment of individuals within this range.
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