Incremental Prognostic Value of Coronary Artery Calcium Progression within a Large Community-Benefit Calcium Score Registry

Figures

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  Central Illustration: Study design and CAC progression clinical trajectories. (Top) Overview of (left) retrospective enrollment and study population and (right) data extraction, MACE event definition, CAC progression and non-progression definitions. (Bottom) Example axial CT CAC images of the proximal left anterior descending artery (LAD) for patients within three distinct CAC trajectories: (left) Non-Progression, (middle) Zero Baseline Progression, and (right) Non-Zero Baseline Progression. The example for Baseline Non-Zero Progression (CAC 1757→5131) is an extreme example for visualization purposes and not representative of the entire subgroup. Each scan acquisition year and CAC1 or CAC2 values are reported at top left (yellow text). The aortic root (Ao) is also labeled for anatomic orientation. Observed risk for each non-progression or progression trajectory are provided as a range of MACE rates (events per 1000 person-years, PY) across definitions. Subsequent clinical decision-making is proposed.

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  Fig. 1. Annual CAC progression characteristics by age, frequency, and baseline CAC status. (A) Histogram illustrating absolute annual CAC progression distribution, (B) average annual change in CAC by age at time of first CAC scan, and (C) yearly incidence rates (% per 100 person-years) of new CAC for patients starting with Zero Baseline CAC, (D) box plots showing annual CAC progression for categories of (left) all progressors regardless of baseline CAC, (middle) Zero Baseline Progression and (right) Non-Zero Baseline Progression. AU/year=Agatston units per year.

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  Fig. 2. Cumulative incidence of MACE among progressors vs. non-progressors. (Top) Cumulative incidence of 3P, 4P and 5P MACE of all progressors (red) vs non-progressors (blue). Pair-wise comparison p-values are reported. (Bottom) Cumulative incidence of MACE for non-progressors (blue) vs progressors categorized as mild (green, 10–50 AU), moderate (orange, 50–150 AU), and severe (red, >150 AU) absolute progression between scans. Number at risk for each group by year is provided.

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  Fig. 3. Association between annualized CAC progression metrics and MACE. Forest plots illustrating models predicting 3P (red), 4P (blue), and 5P (green) MACE using annualized log-transformed (ln[CAC+25]), annualized square-root transformed, and annualized absolute CAC difference for (A) the total patient cohort including non-progressors and all progressors and (B) progressors with CAC1>0 (Non-Zero Baseline) only. All models are adjusted for baseline CAC, age, sex, race, and traditional risk factors including diabetes, smoking, and dyslipidemia.