15-Year prognostic utility of coronary artery calcium scoring for all-cause mortality in the elderly

Bríain T. Hartaigh, Valentina Valenti, Iksung Cho, Joshua Schulman-Marcus, Heidi Gransar, Joseph Knapper, Anita A. Kelkar, Joseph X. Xie, Hyuk Jae Chang, Leslee J. Shaw, Tracy Q. Callister, James K. Min

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Introduction: Prior studies have demonstrated a decline in the predictive ability of conventional risk factors (RF) with advancing age, emphasizing the need for novel tools to improve risk stratification in the elderly. Coronary artery calcification (CAC) is a robust predictor of adverse cardiovascular events, but its long-term prognostic utility beyond RFs in elderly persons is unknown. Methods: A consecutive series of 9715 individuals underwent CAC scoring and were followed for a mean of 14.6 ± 1.1 years. Multivariable Cox proportional hazards regression (HR) with 95% confidence intervals (95% CI) was employed to assess the independent relationship of CAC and RFs with all-cause death. The incremental value of CAC, stratified by age, was examined by using an area under the receiver operator characteristic curve (AUC) and category-free net reclassification improvement (NRI). Results: Of the overall study sample, 728 (7.5%) adults (mean age 74.2 ± 4.2 years; 55.6% female) were 70 years or older, of which 157 (21.6%) died. The presence of any CAC was associated with a >4-fold (95% CI = 2.84-6.59) adjusted risk of death for those over the age of 70, which was higher compared with younger study counterparts, or other measured RFs. For individuals 70 years or older, the discriminatory ability of CAC improved upon that of RFs alone (C statistics 0.764 vs. 0.675, P < 0.001). CAC also enabled improved reclassification (category-free NRI = 84%, P < 0.001) when added to RFs. Conclusion: In a large-scale observational cohort registry, CAC improves prediction, discrimination, and reclassification of elderly individuals at risk for future death.

Original languageEnglish
Pages (from-to)361-366
Number of pages6
JournalAtherosclerosis
Volume246
DOIs
Publication statusPublished - 2016 Mar 1

Fingerprint

Coronary Vessels
Calcium
Mortality
Confidence Intervals
Area Under Curve
Registries
Cause of Death

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Hartaigh, B. T., Valenti, V., Cho, I., Schulman-Marcus, J., Gransar, H., Knapper, J., ... Min, J. K. (2016). 15-Year prognostic utility of coronary artery calcium scoring for all-cause mortality in the elderly. Atherosclerosis, 246, 361-366. https://doi.org/10.1016/j.atherosclerosis.2016.01.039
Hartaigh, Bríain T. ; Valenti, Valentina ; Cho, Iksung ; Schulman-Marcus, Joshua ; Gransar, Heidi ; Knapper, Joseph ; Kelkar, Anita A. ; Xie, Joseph X. ; Chang, Hyuk Jae ; Shaw, Leslee J. ; Callister, Tracy Q. ; Min, James K. / 15-Year prognostic utility of coronary artery calcium scoring for all-cause mortality in the elderly. In: Atherosclerosis. 2016 ; Vol. 246. pp. 361-366.
@article{866d0bb63d2e466fa46d16c436ab180e,
title = "15-Year prognostic utility of coronary artery calcium scoring for all-cause mortality in the elderly",
abstract = "Introduction: Prior studies have demonstrated a decline in the predictive ability of conventional risk factors (RF) with advancing age, emphasizing the need for novel tools to improve risk stratification in the elderly. Coronary artery calcification (CAC) is a robust predictor of adverse cardiovascular events, but its long-term prognostic utility beyond RFs in elderly persons is unknown. Methods: A consecutive series of 9715 individuals underwent CAC scoring and were followed for a mean of 14.6 ± 1.1 years. Multivariable Cox proportional hazards regression (HR) with 95{\%} confidence intervals (95{\%} CI) was employed to assess the independent relationship of CAC and RFs with all-cause death. The incremental value of CAC, stratified by age, was examined by using an area under the receiver operator characteristic curve (AUC) and category-free net reclassification improvement (NRI). Results: Of the overall study sample, 728 (7.5{\%}) adults (mean age 74.2 ± 4.2 years; 55.6{\%} female) were 70 years or older, of which 157 (21.6{\%}) died. The presence of any CAC was associated with a >4-fold (95{\%} CI = 2.84-6.59) adjusted risk of death for those over the age of 70, which was higher compared with younger study counterparts, or other measured RFs. For individuals 70 years or older, the discriminatory ability of CAC improved upon that of RFs alone (C statistics 0.764 vs. 0.675, P < 0.001). CAC also enabled improved reclassification (category-free NRI = 84{\%}, P < 0.001) when added to RFs. Conclusion: In a large-scale observational cohort registry, CAC improves prediction, discrimination, and reclassification of elderly individuals at risk for future death.",
author = "Hartaigh, {Br{\'i}ain T.} and Valentina Valenti and Iksung Cho and Joshua Schulman-Marcus and Heidi Gransar and Joseph Knapper and Kelkar, {Anita A.} and Xie, {Joseph X.} and Chang, {Hyuk Jae} and Shaw, {Leslee J.} and Callister, {Tracy Q.} and Min, {James K.}",
year = "2016",
month = "3",
day = "1",
doi = "10.1016/j.atherosclerosis.2016.01.039",
language = "English",
volume = "246",
pages = "361--366",
journal = "Atherosclerosis",
issn = "0021-9150",
publisher = "Elsevier Ireland Ltd",

}

Hartaigh, BT, Valenti, V, Cho, I, Schulman-Marcus, J, Gransar, H, Knapper, J, Kelkar, AA, Xie, JX, Chang, HJ, Shaw, LJ, Callister, TQ & Min, JK 2016, '15-Year prognostic utility of coronary artery calcium scoring for all-cause mortality in the elderly', Atherosclerosis, vol. 246, pp. 361-366. https://doi.org/10.1016/j.atherosclerosis.2016.01.039

15-Year prognostic utility of coronary artery calcium scoring for all-cause mortality in the elderly. / Hartaigh, Bríain T.; Valenti, Valentina; Cho, Iksung; Schulman-Marcus, Joshua; Gransar, Heidi; Knapper, Joseph; Kelkar, Anita A.; Xie, Joseph X.; Chang, Hyuk Jae; Shaw, Leslee J.; Callister, Tracy Q.; Min, James K.

In: Atherosclerosis, Vol. 246, 01.03.2016, p. 361-366.

Research output: Contribution to journalArticle

TY - JOUR

T1 - 15-Year prognostic utility of coronary artery calcium scoring for all-cause mortality in the elderly

AU - Hartaigh, Bríain T.

AU - Valenti, Valentina

AU - Cho, Iksung

AU - Schulman-Marcus, Joshua

AU - Gransar, Heidi

AU - Knapper, Joseph

AU - Kelkar, Anita A.

AU - Xie, Joseph X.

AU - Chang, Hyuk Jae

AU - Shaw, Leslee J.

AU - Callister, Tracy Q.

AU - Min, James K.

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Introduction: Prior studies have demonstrated a decline in the predictive ability of conventional risk factors (RF) with advancing age, emphasizing the need for novel tools to improve risk stratification in the elderly. Coronary artery calcification (CAC) is a robust predictor of adverse cardiovascular events, but its long-term prognostic utility beyond RFs in elderly persons is unknown. Methods: A consecutive series of 9715 individuals underwent CAC scoring and were followed for a mean of 14.6 ± 1.1 years. Multivariable Cox proportional hazards regression (HR) with 95% confidence intervals (95% CI) was employed to assess the independent relationship of CAC and RFs with all-cause death. The incremental value of CAC, stratified by age, was examined by using an area under the receiver operator characteristic curve (AUC) and category-free net reclassification improvement (NRI). Results: Of the overall study sample, 728 (7.5%) adults (mean age 74.2 ± 4.2 years; 55.6% female) were 70 years or older, of which 157 (21.6%) died. The presence of any CAC was associated with a >4-fold (95% CI = 2.84-6.59) adjusted risk of death for those over the age of 70, which was higher compared with younger study counterparts, or other measured RFs. For individuals 70 years or older, the discriminatory ability of CAC improved upon that of RFs alone (C statistics 0.764 vs. 0.675, P < 0.001). CAC also enabled improved reclassification (category-free NRI = 84%, P < 0.001) when added to RFs. Conclusion: In a large-scale observational cohort registry, CAC improves prediction, discrimination, and reclassification of elderly individuals at risk for future death.

AB - Introduction: Prior studies have demonstrated a decline in the predictive ability of conventional risk factors (RF) with advancing age, emphasizing the need for novel tools to improve risk stratification in the elderly. Coronary artery calcification (CAC) is a robust predictor of adverse cardiovascular events, but its long-term prognostic utility beyond RFs in elderly persons is unknown. Methods: A consecutive series of 9715 individuals underwent CAC scoring and were followed for a mean of 14.6 ± 1.1 years. Multivariable Cox proportional hazards regression (HR) with 95% confidence intervals (95% CI) was employed to assess the independent relationship of CAC and RFs with all-cause death. The incremental value of CAC, stratified by age, was examined by using an area under the receiver operator characteristic curve (AUC) and category-free net reclassification improvement (NRI). Results: Of the overall study sample, 728 (7.5%) adults (mean age 74.2 ± 4.2 years; 55.6% female) were 70 years or older, of which 157 (21.6%) died. The presence of any CAC was associated with a >4-fold (95% CI = 2.84-6.59) adjusted risk of death for those over the age of 70, which was higher compared with younger study counterparts, or other measured RFs. For individuals 70 years or older, the discriminatory ability of CAC improved upon that of RFs alone (C statistics 0.764 vs. 0.675, P < 0.001). CAC also enabled improved reclassification (category-free NRI = 84%, P < 0.001) when added to RFs. Conclusion: In a large-scale observational cohort registry, CAC improves prediction, discrimination, and reclassification of elderly individuals at risk for future death.

UR - http://www.scopus.com/inward/record.url?scp=84960935602&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84960935602&partnerID=8YFLogxK

U2 - 10.1016/j.atherosclerosis.2016.01.039

DO - 10.1016/j.atherosclerosis.2016.01.039

M3 - Article

C2 - 26841073

AN - SCOPUS:84960935602

VL - 246

SP - 361

EP - 366

JO - Atherosclerosis

JF - Atherosclerosis

SN - 0021-9150

ER -