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Prognostic significance of subtle coronary calcification in patients with zero coronary artery calcium score: From the CONFIRM registry.
Atherosclerosis. 2020 09; 309:33-38.A

Abstract

BACKGROUND AND AIMS

The Agatston coronary artery calcium score (CACS) may fail to identify small or less dense coronary calcification that can be detected on coronary CT angiography (CCTA). We investigated the prevalence and prognostic importance of subtle calcified plaques on CCTA among individuals with CACS 0.

METHODS

From the prospective multicenter CONFIRM registry, we evaluated patients without known CAD who underwent CAC scan and CCTA. CACS was categorized as 0, 1-10, 11-100, 101-400, and >400. Patients with CACS 0 were stratified according to the visual presence of coronary plaques on CCTA. Plaque composition was categorized as non-calcified (NCP), mixed (MP) and calcified (CP). The primary outcome was a major adverse cardiac event (MACE) which was defined as death and myocardial infarction.

RESULTS

Of 4049 patients, 1741 (43%) had a CACS 0. NCP and plaques that contained calcium (MP or CP) were detected by CCTA in 110 patients (6% of CACS 0) and 64 patients (4% of CACS 0), respectively. During a 5.6 years median follow-up (IQR 5.1-6.2 years), 413 MACE events occurred (13%). Patients with CACS 0 and MP/CP detected by CCTA had similar MACE risk compared to patients with CACS 1-10 (p = 0.868). In patients with CACS 0, after adjustment for risk factors and symptom, MP/CP was associated with an increased MACE risk compared to those with entirely normal CCTA (HR 2.39, 95% CI [1.09-5.24], p = 0.030).

CONCLUSIONS

A small but non-negligible proportion of patients with CACS 0 had identifiable coronary calcification, which was associated with increased MACE risk. Modifying CAC image acquisition and/or scoring methods could improve the detection of subtle coronary calcification.

Authors+Show Affiliations

Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA.Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA.Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA.Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA.Department of Medicine, University of Erlangen, Erlangen, Germany.Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI, USA.Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA.Department of Radiology/Centre de Recherche, Montreal Heart Institute/Unniversitè de Montreal, Montreal, Quebec, Canada.Department of Radiology/Centre de Recherche, Montreal Heart Institute/Unniversitè de Montreal, Montreal, Quebec, Canada.Tennessee Heart and Vascular Institute, Hendersonville, TN, USA.William Beaumont Hospital, Royal Oaks, MI, USA.Department of Medicine and Radiology, University of Ottawa, ON, Canada.Capitol Cardiology Associate, Albany, NY, USA.Deutsches Herzzentrum Munchen, Munich, Germany.Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany.University Hospital, Zurich, Switzerland.Department of Medicine, Walter Reed Medical Center, Washington, DC, USA.Seoul National University Hospital, Seoul, South Korea.Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada.Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.Baptist Cardiac and Vascular Institute, Miami, FL, USA.Centro Cardiologico Monzino, IRCCS, Milan, Italy.Centro Cardiologico Monzino, IRCCS, Milan, Italy.Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA.Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA.Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA.Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Daniel.Berman@cshs.org.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32862086

Citation

Han, Donghee, et al. "Prognostic Significance of Subtle Coronary Calcification in Patients With Zero Coronary Artery Calcium Score: From the CONFIRM Registry." Atherosclerosis, vol. 309, 2020, pp. 33-38.
Han D, Klein E, Friedman J, et al. Prognostic significance of subtle coronary calcification in patients with zero coronary artery calcium score: From the CONFIRM registry. Atherosclerosis. 2020;309:33-38.
Han, D., Klein, E., Friedman, J., Gransar, H., Achenbach, S., Al-Mallah, M. H., Budoff, M. J., Cademartiri, F., Maffei, E., Callister, T. Q., Chinnaiyan, K., Chow, B. J. W., DeLago, A., Hadamitzky, M., Hausleiter, J., Kaufmann, P. A., Villines, T. C., Kim, Y. J., Leipsic, J., ... Berman, D. S. (2020). Prognostic significance of subtle coronary calcification in patients with zero coronary artery calcium score: From the CONFIRM registry. Atherosclerosis, 309, 33-38. https://doi.org/10.1016/j.atherosclerosis.2020.07.011
Han D, et al. Prognostic Significance of Subtle Coronary Calcification in Patients With Zero Coronary Artery Calcium Score: From the CONFIRM Registry. Atherosclerosis. 2020;309:33-38. PubMed PMID: 32862086.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic significance of subtle coronary calcification in patients with zero coronary artery calcium score: From the CONFIRM registry. AU - Han,Donghee, AU - Klein,Eyal, AU - Friedman,John, AU - Gransar,Heidi, AU - Achenbach,Stephan, AU - Al-Mallah,Mouaz H, AU - Budoff,Matthew J, AU - Cademartiri,Filippo, AU - Maffei,Erica, AU - Callister,Tracy Q, AU - Chinnaiyan,Kavitha, AU - Chow,Benjamin J W, AU - DeLago,Augustin, AU - Hadamitzky,Martin, AU - Hausleiter,Joerg, AU - Kaufmann,Philipp A, AU - Villines,Todd C, AU - Kim,Yong-Jin, AU - Leipsic,Jonathon, AU - Feuchtner,Gudrun, AU - Cury,Ricardo C, AU - Pontone,Gianluca, AU - Andreini,Daniele, AU - Marques,Hugo, AU - Rubinshtein,Ronen, AU - Chang,Hyuk-Jae, AU - Lin,Fay Y, AU - Shaw,Leslee J, AU - Min,James K, AU - Berman,Daniel S, Y1 - 2020/07/29/ PY - 2020/04/08/received PY - 2020/06/18/revised PY - 2020/07/15/accepted PY - 2020/8/31/pubmed PY - 2021/6/24/medline PY - 2020/8/31/entrez KW - Agatston score KW - Computed tomography KW - Coronary artery calcium KW - Coronary artery disease SP - 33 EP - 38 JF - Atherosclerosis JO - Atherosclerosis VL - 309 N2 - BACKGROUND AND AIMS: The Agatston coronary artery calcium score (CACS) may fail to identify small or less dense coronary calcification that can be detected on coronary CT angiography (CCTA). We investigated the prevalence and prognostic importance of subtle calcified plaques on CCTA among individuals with CACS 0. METHODS: From the prospective multicenter CONFIRM registry, we evaluated patients without known CAD who underwent CAC scan and CCTA. CACS was categorized as 0, 1-10, 11-100, 101-400, and >400. Patients with CACS 0 were stratified according to the visual presence of coronary plaques on CCTA. Plaque composition was categorized as non-calcified (NCP), mixed (MP) and calcified (CP). The primary outcome was a major adverse cardiac event (MACE) which was defined as death and myocardial infarction. RESULTS: Of 4049 patients, 1741 (43%) had a CACS 0. NCP and plaques that contained calcium (MP or CP) were detected by CCTA in 110 patients (6% of CACS 0) and 64 patients (4% of CACS 0), respectively. During a 5.6 years median follow-up (IQR 5.1-6.2 years), 413 MACE events occurred (13%). Patients with CACS 0 and MP/CP detected by CCTA had similar MACE risk compared to patients with CACS 1-10 (p = 0.868). In patients with CACS 0, after adjustment for risk factors and symptom, MP/CP was associated with an increased MACE risk compared to those with entirely normal CCTA (HR 2.39, 95% CI [1.09-5.24], p = 0.030). CONCLUSIONS: A small but non-negligible proportion of patients with CACS 0 had identifiable coronary calcification, which was associated with increased MACE risk. Modifying CAC image acquisition and/or scoring methods could improve the detection of subtle coronary calcification. SN - 1879-1484 UR - https://www.unboundmedicine.com/medline/citation/32862086/Prognostic_significance_of_subtle_coronary_calcification_in_patients_with_zero_coronary_artery_calcium_score:_From_the_CONFIRM_registry_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0021-9150(20)30378-6 DB - PRIME DP - Unbound Medicine ER -