BACKGROUND: The extent of coronary artery calcification (CAC) and near-term adverse clinical outcomes are strongly related through 5 years of follow-up. OBJECTIVE: To describe the ability of CAC scores to predict long-term mortality in persons without symptoms of coronary artery disease. DESIGN: Observational cohort. SETTING: Single-center, outpatient cardiology laboratory. PATIENTS: 9715 asymptomatic patients. MEASUREMENTS: Coronary artery calcification scoring and binary risk factor data were collected. The primary end point was time to all-cause mortality (median follow-up, 14.6 years). Univariable and multivariable Cox proportional hazards models were used to compare survival distributions. The net reclassification improvement statistic was calculated. RESULTS: In Cox models adjusted for risk factors for coronary artery disease, the CAC score was highly predictive of all-cause mortality (P < 0.001). Overall 15-year mortality rates ranged from 3% to 28% for CAC scores from 0 to 1000 or greater (P < 0.001). The relative hazard for all-cause mortality ranged from 1.68 for a CAC score of 1 to 10 (P < 0.001) to 6.26 for a score of 1000 or greater (P < 0.001). The categorical net reclassification improvement using cut points of less than 7.5% to 22.5% or greater was 0.21 (95% CI, 0.16 to 0.32). LIMITATIONS: Data collection was limited to a single center with generalizability limitations. Only binary risk factor data were available, and CAC was only measured once. CONCLUSION: The extent of CAC accurately predicts 15-year mortality in a large cohort of asymptomatic patients. Long-term estimates of mortality provide a unique opportunity to examine the value of novel biomarkers, such as CAC, in estimating important patient outcomes. PRIMARY FUNDING SOURCE: None.
BACKGROUND: The extent of coronary artery calcification (CAC) and near-term adverse clinical outcomes are strongly related through 5 years of follow-up. OBJECTIVE: To describe the ability of CAC scores to predict long-term mortality in persons without symptoms of coronary artery disease. DESIGN: Observational cohort. SETTING: Single-center, outpatient cardiology laboratory. PATIENTS: 9715 asymptomatic patients. MEASUREMENTS: Coronary artery calcification scoring and binary risk factor data were collected. The primary end point was time to all-cause mortality (median follow-up, 14.6 years). Univariable and multivariable Cox proportional hazards models were used to compare survival distributions. The net reclassification improvement statistic was calculated. RESULTS: In Cox models adjusted for risk factors for coronary artery disease, the CAC score was highly predictive of all-cause mortality (P < 0.001). Overall 15-year mortality rates ranged from 3% to 28% for CAC scores from 0 to 1000 or greater (P < 0.001). The relative hazard for all-cause mortality ranged from 1.68 for a CAC score of 1 to 10 (P < 0.001) to 6.26 for a score of 1000 or greater (P < 0.001). The categorical net reclassification improvement using cut points of less than 7.5% to 22.5% or greater was 0.21 (95% CI, 0.16 to 0.32). LIMITATIONS: Data collection was limited to a single center with generalizability limitations. Only binary risk factor data were available, and CAC was only measured once. CONCLUSION: The extent of CAC accurately predicts 15-year mortality in a large cohort of asymptomatic patients. Long-term estimates of mortality provide a unique opportunity to examine the value of novel biomarkers, such as CAC, in estimating important patient outcomes. PRIMARY FUNDING SOURCE: None.
Authors: Ramzi Dudum; Omar Dzaye; Mohammadhassan Mirbolouk; Zeina A Dardari; Olusola A Orimoloye; Matthew J Budoff; Daniel S Berman; Alan Rozanski; Michael D Miedema; Khurram Nasir; John A Rumberger; Leslee Shaw; Seamus P Whelton; Garth Graham; Michael J Blaha Journal: J Cardiovasc Comput Tomogr Date: 2019-03-27
Authors: Leslee J Shaw; James K Min; Khurram Nasir; Joe X Xie; Daniel S Berman; Michael D Miedema; Seamus P Whelton; Zeina A Dardari; Alan Rozanski; John Rumberger; C Noel Bairey Merz; Mouaz H Al-Mallah; Matthew J Budoff; Michael J Blaha Journal: Eur Heart J Date: 2018-11-01 Impact factor: 29.983
Authors: H Baradaran; P Patel; G Gialdini; A Giambrone; M P Lerario; B B Navi; J K Min; C Iadecola; H Kamel; A Gupta Journal: AJNR Am J Neuroradiol Date: 2017-07-20 Impact factor: 3.825
Authors: Catherine E Handy; Chintan S Desai; Zeina A Dardari; Mouaz H Al-Mallah; Michael D Miedema; Pamela Ouyang; Matthew J Budoff; Roger S Blumenthal; Khurram Nasir; Michael J Blaha Journal: JACC Cardiovasc Imaging Date: 2016-03-09