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Prognostic implications of coronary artery calcium in the absence of coronary artery luminal narrowing.
Atherosclerosis. 2017 07; 262:185-190.A

Abstract

BACKGROUND AND AIMS

Coronary artery calcium (CAC) scoring is a predictor of future adverse clinical events, and a surrogate measure of overall coronary artery plaque burden. Coronary computed tomographic angiography (CCTA) is a contrast-enhanced method that allows for visualization of plaque as well as whether that plaque causes luminal narrowing. To date, the prognosis of individuals with CAC but without stenosis has not been reported. We explored the prevalence of CAC>0 and its prognostic utility for future mortality for patients without luminal narrowing by CCTA.

METHODS

From 17 sites in 9 countries, we identified patients without known coronary artery disease, who underwent CAC scoring and CCTA, and were followed for >3 years. CCTA was graded for % stenosis according to a modified American Heart Association 16-segment model. We calculated hazard ratios (HR) with 95% confidence intervals (95% CI) for incident mortality and compared risk of death for patients as a function of presence or absence of CAC and presence or absence of luminal narrowing by CCTA.

RESULTS

Among 6656 patients who underwent CCTA and CAC scoring, 399 patients (6.0%) had no coronary luminal narrowing but CAC>0. During a median follow-up of 5.1 years (IQR: 3.9-5.9 years), 456 deaths occurred. Compared to individuals without luminal narrowing or CAC, individuals without luminal narrowing but CAC>0 were older, more likely to be male and had higher rates of diabetes, hypertension, and dyslipidemia. Individuals without luminal narrowing but CAC experienced a 2-fold increased risk of mortality, with increasing risk of mortality with higher CAC score. Following adjustment, incident death persisted (HR, 1.8; 95% CI, 1.1-2.9, p = 0.02) among patients without luminal narrowing but with CAC>0 compared with patients whose CACS = 0. Individuals without luminal narrowing but CAC ≥100 had mortality risks similar to individuals with non-obstructive CAD (0 < stenosis<50%) by CCTA [HR 2.5 (95% CI 1.3-4.9) and 2.2 (95% CI 1.6-3.0), respectively].

CONCLUSIONS

Patients without luminal narrowing but with CAC experience greater risk of 5-year mortality. Patients with CAC score ≥100 and no coronary luminal narrowing experience death rates similar to those with non-obstructive CAD.

Authors+Show Affiliations

Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA; Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA; Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, Adler Geriatric Center, New Haven, USA.Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA.Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.Department of Medicine, NewYork-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.Department of Medicine, University of Erlangen, Erlangen, Germany.Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA.Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA.Tennessee Heart and Vascular Institute, Hendersonville, TN, USA.Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI, USA.Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy and Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.William Beaumont Hospital, Royal Oaks, MI, USA.Department of Medicine and Radiology, University of Ottawa, ON, Canada.Duke Clinical Research Institute, Durham, NC, USA.Capitol Cardiology Associates, Albany, NY, USA.Department of Medicine, Walter Reed Medical Center, Washington, DC, USA.Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany.Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany.Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada.Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.University Hospital, Zurich, Switzerland.Baptist Cardiac and Vascular Institute, Miami, FL, USA.Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.Seoul National University Hospital, Seoul, South Korea.Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy and Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.William Beaumont Hospital, Royal Oaks, MI, USA.Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy.Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy.Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA. Electronic address: jkm2001@med.cornell.edu.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28385391

Citation

Cho, Iksung, et al. "Prognostic Implications of Coronary Artery Calcium in the Absence of Coronary Artery Luminal Narrowing." Atherosclerosis, vol. 262, 2017, pp. 185-190.
Cho I, Ó Hartaigh B, Gransar H, et al. Prognostic implications of coronary artery calcium in the absence of coronary artery luminal narrowing. Atherosclerosis. 2017;262:185-190.
Cho, I., Ó Hartaigh, B., Gransar, H., Valenti, V., Lin, F. Y., Achenbach, S., Berman, D. S., Budoff, M. J., Callister, T. Q., Al-Mallah, M. H., Cademartiri, F., Chinnaiyan, K., Chow, B. J. W., Dunning, A. M., DeLago, A., Villines, T. C., Hadamitzky, M., Hausleiter, J., Leipsic, J., ... Min, J. K. (2017). Prognostic implications of coronary artery calcium in the absence of coronary artery luminal narrowing. Atherosclerosis, 262, 185-190. https://doi.org/10.1016/j.atherosclerosis.2016.12.006
Cho I, et al. Prognostic Implications of Coronary Artery Calcium in the Absence of Coronary Artery Luminal Narrowing. Atherosclerosis. 2017;262:185-190. PubMed PMID: 28385391.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic implications of coronary artery calcium in the absence of coronary artery luminal narrowing. AU - Cho,Iksung, AU - Ó Hartaigh,Bríain, AU - Gransar,Heidi, AU - Valenti,Valentina, AU - Lin,Fay Y, AU - Achenbach,Stephan, AU - Berman,Daniel S, AU - Budoff,Matthew J, AU - Callister,Tracy Q, AU - Al-Mallah,Mouaz H, AU - Cademartiri,Filippo, AU - Chinnaiyan,Kavitha, AU - Chow,Benjamin J W, AU - Dunning,Allison M, AU - DeLago,Augustin, AU - Villines,Todd C, AU - Hadamitzky,Martin, AU - Hausleiter,Joerg, AU - Leipsic,Jonathon, AU - Shaw,Leslee J, AU - Kaufmann,Philipp A, AU - Cury,Ricardo C, AU - Feuchtner,Gudrun, AU - Kim,Yong-Jin, AU - Maffei,Erica, AU - Raff,Gilbert, AU - Pontone,Gianluca, AU - Andreini,Daniele, AU - Chang,Hyuk-Jae, AU - Min,James K, Y1 - 2016/12/03/ PY - 2016/02/03/received PY - 2016/12/01/revised PY - 2016/12/02/accepted PY - 2017/4/8/pubmed PY - 2018/1/30/medline PY - 2017/4/8/entrez KW - Coronary artery calcium scoring KW - Coronary artery disease KW - Coronary computed tomographic angiography SP - 185 EP - 190 JF - Atherosclerosis JO - Atherosclerosis VL - 262 N2 - BACKGROUND AND AIMS: Coronary artery calcium (CAC) scoring is a predictor of future adverse clinical events, and a surrogate measure of overall coronary artery plaque burden. Coronary computed tomographic angiography (CCTA) is a contrast-enhanced method that allows for visualization of plaque as well as whether that plaque causes luminal narrowing. To date, the prognosis of individuals with CAC but without stenosis has not been reported. We explored the prevalence of CAC>0 and its prognostic utility for future mortality for patients without luminal narrowing by CCTA. METHODS: From 17 sites in 9 countries, we identified patients without known coronary artery disease, who underwent CAC scoring and CCTA, and were followed for >3 years. CCTA was graded for % stenosis according to a modified American Heart Association 16-segment model. We calculated hazard ratios (HR) with 95% confidence intervals (95% CI) for incident mortality and compared risk of death for patients as a function of presence or absence of CAC and presence or absence of luminal narrowing by CCTA. RESULTS: Among 6656 patients who underwent CCTA and CAC scoring, 399 patients (6.0%) had no coronary luminal narrowing but CAC>0. During a median follow-up of 5.1 years (IQR: 3.9-5.9 years), 456 deaths occurred. Compared to individuals without luminal narrowing or CAC, individuals without luminal narrowing but CAC>0 were older, more likely to be male and had higher rates of diabetes, hypertension, and dyslipidemia. Individuals without luminal narrowing but CAC experienced a 2-fold increased risk of mortality, with increasing risk of mortality with higher CAC score. Following adjustment, incident death persisted (HR, 1.8; 95% CI, 1.1-2.9, p = 0.02) among patients without luminal narrowing but with CAC>0 compared with patients whose CACS = 0. Individuals without luminal narrowing but CAC ≥100 had mortality risks similar to individuals with non-obstructive CAD (0 < stenosis<50%) by CCTA [HR 2.5 (95% CI 1.3-4.9) and 2.2 (95% CI 1.6-3.0), respectively]. CONCLUSIONS: Patients without luminal narrowing but with CAC experience greater risk of 5-year mortality. Patients with CAC score ≥100 and no coronary luminal narrowing experience death rates similar to those with non-obstructive CAD. SN - 1879-1484 UR - https://www.unboundmedicine.com/medline/citation/28385391/Prognostic_implications_of_coronary_artery_calcium_in_the_absence_of_coronary_artery_luminal_narrowing_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0021-9150(16)31527-1 DB - PRIME DP - Unbound Medicine ER -