TY - JOUR
T1 - Prognostic significance of subtle coronary calcification in patients with zero coronary artery calcium score
T2 - 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.
N1 - Funding Information:
The work was supported in part by the Dr. Miriam and Sheldon G. Adelson Medical Research Foundation .
Funding Information:
The work was supported in part by the Dr. Miriam and Sheldon G. Adelson Medical Research Foundation.J.K.M. receives funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare; has serves on the scientific advisory board of Arineta and GE Healthcare; and has an equity interest in Cleerly. All other authors have no conflict of interest to declare.
Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/9
Y1 - 2020/9
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.
AB - 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.
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U2 - 10.1016/j.atherosclerosis.2020.07.011
DO - 10.1016/j.atherosclerosis.2020.07.011
M3 - Article
C2 - 32862086
AN - SCOPUS:85089848065
SN - 0021-9150
VL - 309
SP - 33
EP - 38
JO - Atherosclerosis
JF - Atherosclerosis
ER -