Coronary Artery Calcium for Risk Stratification of Sudden Cardiac Death The Coronary Artery Calcium Consortium

• Type of Material: Article
• Authors: Alexander C Razavi, Johns Hopkins University; S.M. Iftekhar Uddin, Johns Hopkins University; Zeina A Dardari, Johns Hopkins University; Daniel S Berman, Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Matthew J Budoff, Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, United States; Michael D Miedema, Minneapolis Heart Institute and Foundation, Minneapolis, MN, United States; Albert D Osei, Johns Hopkins University; Olufunmilayo H Obisesan, Johns Hopkins University; Khurram Nasir, Methodist DeBakey Heart & Vascular Center, Houston, TX, United States; Alan Rozanski, Division of Cardiology, Mount Sinai, St Luke’s Hospital, New York, NY, United States; John A Rumberger, Department of Cardiac Imaging, Princeton Longevity Center, Princeton, NJ, United States; Lesleer Shaw, Department of Radiology, Weill Cornell Medicine, New York, NY, United States; Laurence Sperling, Emory University; Seamus P Whelton, Johns Hopkins University; Martin Bødtker Mortensen, Johns Hopkins University; Michael J Blaha, Johns Hopkins University; Omar Dzaye, Johns Hopkins University
• Language: English
• Date: 2022-07-04
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 by the American College of Cardiology Foundation. Published by Elsevier.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jcmg.2022.02.011
• Title of Journal or Parent Work: JACC-CARDIOVASCULAR IMAGING
• Volume: 15
• Issue: 7
• Start Page: 1259
• End Page: 1270
• Grant/Funding Information: This project was supported in part by a research grant from the National Institutes of Health (NIH)-National Heart, Lung, and Blood Institute (NHLBI) [L30 HL110027].
• Keywords: EVENTS; cardiovascular diseases; multidetector computed tomography; AGE; sudden cardiac death; Life Sciences & Biomedicine; PLAQUE; Cardiac & Cardiovascular Systems; Radiology, Nuclear Medicine & Medical Imaging; Cardiovascular System & Cardiology; coronary artery calcium; HEART; PREVALENCE; ASSOCIATION; DISEASE; Science & Technology; OUTCOMES; PREDICTOR
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background: Coronary artery calcium (CAC) is a marker of plaque burden. Whether CAC improves risk stratification for incident sudden cardiac death (SCD) beyond atherosclerotic cardiovascular disease (ASCVD) risk factors is unknown. Objectives: SCD is a common initial manifestation of coronary heart disease (CHD); however, SCD risk prediction remains elusive. Methods: The authors studied 66,636 primary prevention patients from the CAC Consortium. Multivariable competing risks regression and C-statistics were used to assess the association between CAC and SCD, adjusting for demographics and traditional risk factors. Results: The mean age was 54.4 years, 33% were women, 11% were of non-White ethnicity, and 55% had CAC >0. A total of 211 SCD events (0.3%) were observed during a median follow-up of 10.6 years, 91% occurring among those with baseline CAC >0. Compared with CAC = 0, there was a stepwise higher risk (P trend < 0.001) in SCD for CAC 100 to 399 (subdistribution hazard ratio [SHR]: 2.8; 95% CI: 1.6-5.0), CAC 400 to 999 (SHR: 4.0; 95% CI: 2.2-7.3), and CAC >1,000 (SHR: 4.9; 95% CI: 2.6-9.9). CAC provided incremental improvements in the C-statistic for the prediction of SCD among individuals with a 10-year risk <7.5% (ΔC-statistic = +0.046; P = 0.02) and 7.5% to 20% (ΔC-statistic = +0.069; P = 0.003), which were larger when compared with persons with a 10-year risk >20% (ΔC-statistic = +0.01; P = 0.54). Conclusions: Higher CAC burden strongly associates with incident SCD beyond traditional risk factors, particularly among primary prevention patients with low-intermediate risk. SCD risk stratification can be useful in the early stages of CHD through the measurement of CAC, identifying patients most likely to benefit from further downstream testing.