Prognostic implications of coronary artery calcium in the absence of coronary artery luminal narrowing

• Type of Material: Article
• Authors: Iksung Cho, NewYork-Presbyterian Hospital; Bríain ó Hartaigh, NewYork-Presbyterian Hospital; Heidi Gransar, Cedars Sinai Medical Center; Valentina Valenti, NewYork-Presbyterian Hospital; Fay Y. Lin, NewYork-Presbyterian Hospital; Stephan Achenbach, University of Erlangen; Daniel S Berman, Cedars Sinai Medical Center; Matthew J. Budoff, University of California; Tracy Q. Callister, Tennessee Heart and Vascular Institute; Mouaz H. Al-Mallah, Wayne State University; Filippo Cademartiri, Giovanni XXIII Hospital; Kavitha Chinnaiyan, William Beaumont Hospital; Benjamin J. W. Chow, University of Ottawa; Allison M. Dunning, Duke University; Augustin DeLago, Capitol Cardiology Associates; Todd C. Villines, Walter Reed Medical Center; Martin Hadamitzky, Deutsches Herzzentrum Munchen; Joerg Hausleiter, Universität München; Jonathon Leipsic, University of British Columbia; Leslee J Shaw, Emory University; Philipp A. Kaufmann, University Hospital; Ricardo C. Cury, Baptist Cardiac & Vascular Institute; Gudrun Feuchtner, University of Innsbruck; Yong-Jin Kim, Seoul National University; Erica Maffei, Giovanni XXIII Hospital; Gilbert Raff, William Beaumont Hospital; Gianluca Pontone, University of Milan; Daniele Andreini, University of Milan; Hyuk-Jae Chang, Yonsei University; James K. Min, NewYork-Presbyterian Hospital
• Language: English
• Date: 2017-07-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 The Authors
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.atherosclerosis.2016.12.006
• Title of Journal or Parent Work: Atherosclerosis
• ISSN: 0021-9150
• Volume: 262
• Start Page: 185
• End Page: 190
• Grant/Funding Information: This work was also supported by the IT R&D program of MSIP/KEIT. [10044910, Development of Multi-modality Imaging and 3D Simulation-Based Integrative Diagnosis-Treatment Support Software System for Cardiovascular Diseases.; Research reported in this publication was supported by the Heart Lung and Blood Institute of the National institutes of Health (Bethesda, MD, USA) under award number R01 HL115150, and funded, in part, by a generous gift from the Dalio Institute of Cardiovascular Imaging (New York, NY, USA) and the Michael Wolk Foundation (New York, NY, USA).
• Keywords: Life Sciences & Biomedicine; INTERMEDIATE; RISK; COMMITTEE; DISEASE; Cardiac & Cardiovascular Systems; CARDIOVASCULAR-COMPUTED-TOMOGRAPHY; SOCIETY; Coronary computed tomographic; Coronary artery disease; Coronary artery calcium scoring; Peripheral Vascular Disease; Cardiovascular System & Cardiology; CT ANGIOGRAPHY; angiography; Science & Technology
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Radiology

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.