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

Iksung Cho; Bríain ó Hartaigh; Heidi Gransar; Valentina Valenti; Fay Y. Lin; Stephan Achenbach; Daniel S. Berman; Matthew J. Budoff; Tracy Q. Callister; Mouaz H. Al-Mallah; Filippo Cademartiri; Kavitha Chinnaiyan; Benjamin J.W. Chow; Allison M. Dunning; Augustin DeLago; Todd C. Villines; Martin Hadamitzky; Joerg Hausleiter; Jonathon Leipsic; Leslee J. Shaw; Philipp A. Kaufmann; Ricardo C. Cury; Gudrun Feuchtner; Yong Jin Kim; Erica Maffei; Gilbert Raff; Gianluca Pontone; Daniele Andreini; Hyuk Jae Chang; James K. Min

doi:10.1016/j.atherosclerosis.2016.12.006

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

Iksung Cho, Bríain ó Hartaigh, Heidi Gransar, Valentina Valenti, Fay Y. Lin, Stephan Achenbach, Daniel S. Berman, Matthew J. Budoff, Tracy Q. Callister, Mouaz H. Al-Mallah, Filippo Cademartiri, Kavitha Chinnaiyan, Benjamin J.W. Chow, Allison M. Dunning, Augustin DeLago, Todd C. Villines, Martin Hadamitzky, Joerg Hausleiter, Jonathon Leipsic, Leslee J. ShawPhilipp A. Kaufmann, Ricardo C. Cury, Gudrun Feuchtner, Yong Jin Kim, Erica Maffei, Gilbert Raff, Gianluca Pontone, Daniele Andreini, Hyuk Jae Chang, James K. Min

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

14 Citations (Scopus)

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.

Original language	English
Pages (from-to)	185-190
Number of pages	6
Journal	Atherosclerosis
Volume	262
DOIs	https://doi.org/10.1016/j.atherosclerosis.2016.12.006
Publication status	Published - 2017 Jul

Bibliographical note

Funding Information:
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). 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.

Publisher Copyright:
© 2016 The Authors

All Science Journal Classification (ASJC) codes

Cardiology and Cardiovascular Medicine

UN SDGs

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10.1016/j.atherosclerosis.2016.12.006

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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

@article{ef31e989690648f7a15e1a8488781d73,

title = "Prognostic implications of coronary artery calcium in the absence of coronary artery luminal narrowing",

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.",

author = "Iksung Cho and {{\'o} Hartaigh}, Br{\'i}ain and Heidi Gransar and Valentina Valenti and Lin, {Fay Y.} and Stephan Achenbach and Berman, {Daniel S.} and Budoff, {Matthew J.} and Callister, {Tracy Q.} and Al-Mallah, {Mouaz H.} and Filippo Cademartiri and Kavitha Chinnaiyan and Chow, {Benjamin J.W.} and Dunning, {Allison M.} and Augustin DeLago and Villines, {Todd C.} and Martin Hadamitzky and Joerg Hausleiter and Jonathon Leipsic and Shaw, {Leslee J.} and Kaufmann, {Philipp A.} and Cury, {Ricardo C.} and Gudrun Feuchtner and Kim, {Yong Jin} and Erica Maffei and Gilbert Raff and Gianluca Pontone and Daniele Andreini and Chang, {Hyuk Jae} and Min, {James K.}",

note = "Funding Information: 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). 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. Publisher Copyright: {\textcopyright} 2016 The Authors",

year = "2017",

month = jul,

doi = "10.1016/j.atherosclerosis.2016.12.006",

language = "English",

volume = "262",

pages = "185--190",

journal = "Atherosclerosis",

issn = "0021-9150",

publisher = "Elsevier Ireland Ltd",

}

Cho, I, ó Hartaigh, B, Gransar, H, Valenti, V, Lin, FY, Achenbach, S, Berman, DS, Budoff, MJ, Callister, TQ, Al-Mallah, MH, Cademartiri, F, Chinnaiyan, K, Chow, BJW, Dunning, AM, DeLago, A, Villines, TC, Hadamitzky, M, Hausleiter, J, Leipsic, J, Shaw, LJ, Kaufmann, PA, Cury, RC, Feuchtner, G, Kim, YJ, Maffei, E, Raff, G, Pontone, G, Andreini, D, Chang, HJ & Min, JK 2017, 'Prognostic implications of coronary artery calcium in the absence of coronary artery luminal narrowing', Atherosclerosis, vol. 262, pp. 185-190. https://doi.org/10.1016/j.atherosclerosis.2016.12.006

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.

N1 - Funding Information: 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). 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. Publisher Copyright: © 2016 The Authors

PY - 2017/7

Y1 - 2017/7

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.

AB - 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.

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DO - 10.1016/j.atherosclerosis.2016.12.006

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SN - 0021-9150

VL - 262

SP - 185

EP - 190

JO - Atherosclerosis

JF - Atherosclerosis

ER -

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

Abstract

Bibliographical note

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UN SDGs

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