Richard A P Takx1, Ivana Išgum2, Martin J Willemink3, Yolanda van der Graaf4, Harry J de Koning5, Rozemarijn Vliegenthart6, Matthijs Oudkerk7, Tim Leiner3, Pim A de Jong3. 1. Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands. Electronic address: rtakx@umcutrecht.nl. 2. Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands. 3. Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands. 4. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. 5. Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands. 6. Center for Medical Imaging-North East Netherlands, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 7. Center for Medical Imaging-North East Netherlands, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Abstract
OBJECTIVE: To evaluate the incremental prognostic value of the number and maximum volume of coronary artery calcifications over modified Agatston score strata, age, pack-years, and smoking status for predicting cardiovascular events. METHODS: A total of 3559 male current and former smokers received a CT examination for lung cancer screening. Smoking characteristics, patient demographics, and physician-diagnosed cardiovascular events were collected. Images were acquired without electrocardiography gating on 16-slice CT scanners. The association between the presence of both fatal and nonfatal cardiovascular events and the predictors was quantified using Cox proportional hazard analysis. RESULTS: Median follow-up period was 2.9 years. Incident cardiovascular events occurred in 186 participants. Adjusted hazard ratios for modified Agatston score strata of 1 to 10, 11 to 100, 101 to 400, and >400 were 3.39 (95% confidence interval [CI], 1.20-9.59), 6.52 (95% CI, 2.73-15.60), 6.58 (95% CI, 2.75-15.78), and 12.58 (95% CI, 5.42-29.16), respectively. Moreover, comparing the models with and without modified Agatston score strata to the model with age, pack-years, and smoking status yielded a significantly better net reclassification improvement (NRI; 27.3%; P < .0001). Adding the number of calcifications to the model with age, pack-years, smoking status, and modified Agatston score strata resulted in a slightly better NRI (1.68%; P = .0490) with a hazard ratio of 1.13 (95% CI, 1.05-1.21) per 10 calcifications. The incremental prognostic information contained in the volume of the largest calcification was not statistically significant (NRI, 0.14%; P = .3458). CONCLUSION:Cardiovascular event rate increased with higher numbers of calcified lesions. The number but not maximum volume of calcifications has independent, although minimal, prognostic value over age, pack-years, smoking status, and modified Agatston score strata in our population.
RCT Entities:
OBJECTIVE: To evaluate the incremental prognostic value of the number and maximum volume of coronary artery calcifications over modified Agatston score strata, age, pack-years, and smoking status for predicting cardiovascular events. METHODS: A total of 3559 male current and former smokers received a CT examination for lung cancer screening. Smoking characteristics, patient demographics, and physician-diagnosed cardiovascular events were collected. Images were acquired without electrocardiography gating on 16-slice CT scanners. The association between the presence of both fatal and nonfatal cardiovascular events and the predictors was quantified using Cox proportional hazard analysis. RESULTS: Median follow-up period was 2.9 years. Incident cardiovascular events occurred in 186 participants. Adjusted hazard ratios for modified Agatston score strata of 1 to 10, 11 to 100, 101 to 400, and >400 were 3.39 (95% confidence interval [CI], 1.20-9.59), 6.52 (95% CI, 2.73-15.60), 6.58 (95% CI, 2.75-15.78), and 12.58 (95% CI, 5.42-29.16), respectively. Moreover, comparing the models with and without modified Agatston score strata to the model with age, pack-years, and smoking status yielded a significantly better net reclassification improvement (NRI; 27.3%; P < .0001). Adding the number of calcifications to the model with age, pack-years, smoking status, and modified Agatston score strata resulted in a slightly better NRI (1.68%; P = .0490) with a hazard ratio of 1.13 (95% CI, 1.05-1.21) per 10 calcifications. The incremental prognostic information contained in the volume of the largest calcification was not statistically significant (NRI, 0.14%; P = .3458). CONCLUSION: Cardiovascular event rate increased with higher numbers of calcified lesions. The number but not maximum volume of calcifications has independent, although minimal, prognostic value over age, pack-years, smoking status, and modified Agatston score strata in our population.
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