Coronary Calcium as a Predictor of Coronary Events in Four Racial or Ethnic Groups

Detrano, Robert; Guerci, Alan D.; Carr, J. Jeffrey; Bild, Diane E.; Burke, Gregory L.; Folsom, Aaron R.; Liu, Kiang; Shea, Steven; Szklo, Moysés; Bluemke, David A.; O’Leary, Daniel H.; Tracy, Russell P.; Watson, Karol E.; Wong, Nathan D.; Kronmal, Richard A.

doi:10.1056/nejmoa072100

Cited by 2,593 publications

(1,821 citation statements)

References 27 publications

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“…The prognostic value of CAC testing been well validated in multiple studies, including Dallas Heart 12 Rotterdam, 13 St Francis, 14 Multi-Ethnic Study of Atherosclerosis (MESA) 15 and the HeinzNixdorf Recall 16 among others. CAC has been shown to be the best predictor of future events in the general population, 13e15 the elderly, 13,17 and in persons with diabetes.…”

Section: Evidence Supporting Cac For Risk Assessmentmentioning

confidence: 99%

2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology

Hecht

Cronin

Blaha

et al. 2017

Journal of Cardiovascular Computed Tomography

362

231

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Section: Evidence Supporting Cac For Risk Assessmentmentioning

confidence: 99%

2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology

Hecht

Cronin

Blaha

et al. 2017

Journal of Cardiovascular Computed Tomography

362

231

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“…Development and progression of atherosclerosis are strongly associated with major cardiovascular risk factors. Subclinical atherosclerosis manifesting as coronary artery calcification (CAC) is associated with future coronary heart disease (CHD), independent of traditional risk factors, and CAC improves discrimination and classification of CHD risk overall and in persons at intermediate risk by placing more persons in the most extreme risk categories 3, 4. Similar associations with incident CHD and/or CVD have been reported for noncoronary calcifications including the thoracic and abdominal aorta using either plain radiographs5, 6, 7, 8, 9 or computed tomography (CT) scans10, 11, 12 and for aortic sclerosis using echocardiography 13.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Event Prediction and Risk Reclassification by Coronary, Aortic, and Valvular Calcification in the Framingham Heart Study

Hoffmann

Massaro

D’Agostino

et al. 2016

JAHA

175

146

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BackgroundWe determined whether vascular and valvular calcification predicted incident major coronary heart disease, cardiovascular disease (CVD), and all‐cause mortality independent of Framingham risk factors in the community‐based Framingham Heart Study.Methods and ResultsCoronary artery calcium (CAC), thoracic and abdominal aortic calcium, and mitral or aortic valve calcium were measured by cardiac computed tomography in participants free of CVD. Participants were followed for a median of 8 years. Multivariate Cox proportional hazards models were used to determine association of CAC, thoracic and abdominal aortic calcium, and mitral and aortic valve calcium with end points. Improvement in discrimination beyond risk factors was tested via the C‐statistic and net reclassification index. In this cohort of 3486 participants (mean age 50±10 years; 51% female), CAC was most strongly associated with major coronary heart disease, followed by major CVD, and all‐cause mortality independent of Framingham risk factors. Among noncoronary calcifications, mitral valve calcium was associated with major CVD and all‐cause mortality independent of Framingham risk factors and CAC. CAC significantly improved discriminatory value beyond risk factors for coronary heart disease (area under the curve 0.78–0.82; net reclassification index 32%, 95% CI 11–53) but not for CVD. CAC accurately reclassified 85% of the 261 patients who were at intermediate (5–10%) 10‐year risk for coronary heart disease based on Framingham risk factors to either low risk (n=172; no events observed) or high risk (n=53; observed event rate 8%).Conclusions CAC improves discrimination and risk reclassification for major coronary heart disease and CVD beyond risk factors in asymptomatic community‐dwelling persons and accurately reclassifies two‐thirds of the intermediate‐risk population.

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“…An elevated CACS may portend an increased risk of cardiovascular events in some patients 33. Specifically, the MESA study (Multi‐Ethnic Study of Atherosclerosis) with 6722 patients followed for an average of 3.8 years showed that those with CACS >300 have a nearly 10‐fold increased risk of coronary event across ethnic groups 34. Shah et al35 investigated the prognostic significance of calcified plaque among symptomatic patients with nonobstructive coronary artery disease.…”

Section: Multimodality Imaging Techniquesmentioning

confidence: 99%

Imaging Cardiovascular Calcification

Wang

Osborne

Tung

et al. 2018

JAHA

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Coronary Calcium as a Predictor of Coronary Events in Four Racial or Ethnic Groups

Cited by 2,593 publications

References 27 publications

2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology

2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology

Cardiovascular Event Prediction and Risk Reclassification by Coronary, Aortic, and Valvular Calcification in the Framingham Heart Study

Imaging Cardiovascular Calcification

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