Usefulness of Regional Distribution of Coronary Artery Calcium to Improve the Prediction of All-Cause Mortality

Tota-Maharaj, Rajesh; Joshi, Parag H.; Budoff, Matthew J.; Whelton, Seamus P.; Zeb, Irfan; Rumberger, John A.; Al-Mallah, Mouaz; Blumenthal, Roger S.; Nasir, Khurram; Blaha, Michael J.

doi:10.1016/j.amjcard.2015.01.555

Cited by 63 publications

(34 citation statements)

References 22 publications

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“…This should include registry studies of clinical CAC scanning, as most clinical cardiac CT centers have routinely reported CAC on a per-vessel basis 28 .…”

Section: Discussionmentioning

confidence: 99%

“…The traditional Agatston CAC score has persisted for decades, but emerging evidence has suggested novel ways of improving the score 28 . An advantage of simple consideration of number of vessels with CAC is that it also easy to quantify on non-gated chest CTs ordered for non-cardiac indications, which is a rapidly expanding application of CAC scoring 29 .…”

Section: Discussionmentioning

confidence: 99%

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Improving the CAC Score by Addition of Regional Measures of Calcium Distribution

Blaha¹,

Budoff

Tota-Maharaj

et al. 2016

JACC: Cardiovascular Imaging

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118

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Objective We investigated whether inclusion of simple measures of calcified plaque distribution might improve the ability of the traditional Agatston coronary artery calcium (CAC) score to predict cardiovascular events. Background Agatston CAC scoring does not include information on the location and distributional pattern of detectable calcified plaque. Methods We studied 3,262 (50%) individuals with baseline CAC >0 from the Multi-Ethnic Study of Atherosclerosis (MESA). Multi-vessel CAC was defined by the number of coronary vessels with CAC (scored 1 to 4, including the left main). The “diffusivity index” was calculated as 1 – (CAC in most affected vessel/total CAC), and was used to group participants into concentrated and diffuse CAC patterns. Multivariable Cox proportional hazards regression, area under the curve (AUC), and net reclassification improvement (NRI) analyses were performed for both coronary heart disease (CHD) and cardiovascular disease (CVD) events to assess whether measures of regional CAC distribution add to the traditional Agatston CAC score. Results Mean age of the population was 66 ± 10 years, with 42% women. Median follow-up was 10.0 (9.5 – 10.7) years and there were 368 CHD and 493 CVD events during follow-up. Considerable heterogeneity existed between CAC score group and number of vessels with CAC (p<0.01). Addition of number of vessels with CAC significantly improved capacity to predict CHD and CVD events in survival analysis (HR 1.9-3.5 for 4-vessel vs. 1-vessel CAC), AUC analysis (C-statistic improvement of 0.01-0.033), and NRI analysis (category-less NRI 0.10-0.45) analyses. While a diffuse CAC pattern was associated with worse outcomes in participants with ≥2 vessels with CAC (HR 1.33-1.41, p<0.05), adding this variable to the Agatston CAC score and number of vessels with CAC did not further improve global risk prediction. Conclusion The number of coronary arteries with calcified plaque, indicating increasingly “diffuse” multi-vessel subclinical atherosclerosis, adds significantly to the traditional Agatston CAC score for the prediction of CHD and CVD events.

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“…This should include registry studies of clinical CAC scanning, as most clinical cardiac CT centers have routinely reported CAC on a per-vessel basis 28 .…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Improving the CAC Score by Addition of Regional Measures of Calcium Distribution

Blaha¹,

Budoff

Tota-Maharaj

et al. 2016

JACC: Cardiovascular Imaging

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118

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“…The simple CAC-DRS integration of severity and dispersion of CAC was proposed based on studies from the multi-Ethnic Study of Atherosclerosis (MESA), which showed that number of vessels with CAC have prognostic significance beyond absolute CAC score, particularly in the CAC range of 1-300. 12,13 For this study, the CAC-DRS categories were defined using A X /N Y scoring (using Agatston score data and number of vessels with CAC). Therefore, CAC-DRS scores ranged from A0 to A3/N4.…”

Section: Definition Of Cac-drs: Coronary Artery Calcium Data and Repomentioning

confidence: 99%

Validation of the Coronary Artery Calcium Data and Reporting System (CAC-DRS): Dual importance of CAC score and CAC distribution from the Coronary Artery Calcium (CAC) consortium

Dzaye

Dudum

Mirbolouk³

et al. 2020

Journal of Cardiovascular Computed Tomography

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Background: The Coronary Artery Calcium Data and Reporting System (CAC-DRS), which takes into account the Agatston score category (A) and the number of calcified vessels (N) has not yet been validated in terms of its prognostic significance. Methods: We included 54,678 patients from the CAC Consortium, a large retrospective clinical cohort of asymptomatic individuals free of baseline cardiovascular disease (CVD). CAC-DRS groups were derived from routine, cardiac-gated CAC scans. Cox proportional hazards regression models, adjusted for traditional CVD risk factors, were used to assess the association between CAC-DRS groups and CHD, CVD, and all-cause mortality. CAC-DRS was then compared to CAC score groups and regional CAC distribution using area under the curve (AUC) analysis. Results: The study population had a mean age of 54.2 ± 10.7, 34.4% female, and mean ASCVD score 7.3% ± 9.0. Over a mean follow-up of 12 ± 4 years, a total of 2,469 deaths (including 398 CHD deaths and 762 CVD deaths) were recorded. There was a graded risk for CHD, CVD and all-cause mortality with increasing CAC-DRS groups ranging from an all-cause mortality rate of 1.2 per 1,000 person-years for A0 to 15.4 per 1,000 person-years for A3/N4. In multivariable-adjusted models, those with CAC-DRS A3/N4 had significantly higher risk for CHD mortality (HR 5.9 (95% CI 3.6-9.9), CVD mortality (HR4.0 (95% CI 2.8-5.7), and all-cause mortality a (HR 2.5 (95% CI 2.1-3.0) compared to CAC-DRS A0. CAC-DRS had higher AUC than CAC score groups (0.762 vs 0.754, P < 0.001) and CAC distribution (0.762 vs 0.748, P < 0.001). Conclusion: The CAC-DRS system, combining the Agatston score and the number of vessels with CAC provides better stratification of risk for CHD, CVD, and all-cause death than the Agatston score alone. These prognostic data strongly support new SCCT guidelines recommending the use CAC-DRS scoring.

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“…Further, a retrospective study of 23,057 patients found a significant relationship between the number of coronary arteries (right, left main, left anterior and left circumflex) with calcification in each patient and all‐cause mortality within 7 years of the initial measurement of calcium burden (Tota‐Maharaj et al . ). The compiled data from these studies suggest a strong link between cardiovascular calcification and morbidity/mortality that has challenged previously held notions that calcification stabilizes atherosclerotic plaques.…”

Section: Vascular Calcification Predicts Cardiovascular Morbidity Andmentioning

confidence: 97%

Zooming in on the genesis of atherosclerotic plaque microcalcifications

Ruiz

Weinbaum

Aikawa

et al. 2016

The Journal of Physiology

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Epidemiological evidence conclusively demonstrates that calcium burden is a significant predictor of cardiovascular morbidity and mortality; however, the underlying mechanisms remain largely unknown. These observations have challenged the previously held notion that calcification serves to stabilize the atherosclerotic plaque. Recent studies have shown that microcalcifications that form within the fibrous cap of the plaques lead to the accrual of plaque-destabilizing

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Usefulness of Regional Distribution of Coronary Artery Calcium to Improve the Prediction of All-Cause Mortality

Abstract: Background: While the traditional Agatston coronary artery calcium (CAC) score is a powerful

Cited by 63 publications

References 22 publications

Improving the CAC Score by Addition of Regional Measures of Calcium Distribution

Improving the CAC Score by Addition of Regional Measures of Calcium Distribution

Validation of the Coronary Artery Calcium Data and Reporting System (CAC-DRS): Dual importance of CAC score and CAC distribution from the Coronary Artery Calcium (CAC) consortium

Zooming in on the genesis of atherosclerotic plaque microcalcifications

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