Usefulness of Regional Distribution of Coronary Artery Calcium to Improve the Prediction of All-Cause Mortality
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Key result
Increasing the number of vessels with coronary artery calcium was associated with an incrementally higher risk of all-cause mortality (4-vessel HR 2.22) after adjusting for the Agatston score.
Why the study?
Does the regional distribution of coronary artery calcium (CAC) improve the prediction of all-cause mortality compared to the traditional Agatston CAC score in asymptomatic individuals?
Population
23,058 asymptomatic individuals referred for electron beam computed tomography for the assessment of…
Comparison
Assessment of regional distribution of coronary… vs Single-vessel CAC, concentrated CAC, or…
Design
Cohort, Ascertainment of mortality was verified by individuals blinded to…
Follow-up
mean 5.6 to 6.6 years
Authors
Discussion
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Implication
May enhance CAC-based risk stratification in asymptomatic patients; leaves open need for prospective validation before clinical adoption.
Study Design
Type
Cohort (n=23,058)
Multicenter
Yes
Structured PICO
Does the regional distribution of coronary artery calcium (CAC) improve the prediction of all-cause mortality compared to the traditional Agatston CAC score in asymptomatic individuals?
P
Population
23,058 asymptomatic individuals referred for electron beam computed tomography (EBCT) for the assessment of subclinical atherosclerosis (Agatston CAC scoring), free of known CAD. Mean age 55-58 years, 69-78% male, US-based.
I
Intervention
Assessment of regional distribution of coronary artery calcium (CAC), including the number of vessels with CAC (0 to 4, including left main), 'diffuse' CAC pattern, and left main CAC involvement.
C
Comparator
Single-vessel CAC, concentrated CAC, or traditional Agatston CAC score alone.
O
Outcome
All-cause mortality ascertained through the social security death index over mean 5.6 to 6.6 years follow-up.hard clinical
Main Result
Effect estimate: HR 2.22
The regional distribution of coronary artery calcium, including the number of vessels involved and left main disease, significantly improves the prediction of all-cause mortality beyond the traditional Agatston score.
Limitations
- Potential for referral bias since patients were referred by primary care physicians based on cardiovascular risk factors
- Cardiovascular risk factors were assessed by a questionnaire, which may introduce recall bias
- Did not assess cardiovascular causes of death or non-fatal myocardial infarction
- Definitions of diffuse and concentrated CAC, as well as CAC diffusivity, were arbitrary
- Potential for referral bias given patients were referred by primary care physicians based on cardiovascular risk factors
- Cardiovascular risk factors were assessed by a questionnaire format, suggesting recall bias
Cite This Study
Tota-Maharaj et al. (2015) conducted a cohort in Subclinical atherosclerosis (n=23,058). Multi-vessel coronary artery calcium (CAC) vs. Single-vessel CAC was evaluated on All-cause mortality (HR 2.22). Increasing the number of vessels with coronary artery calcium was associated with an incrementally higher risk of all-cause mortality (4-vessel HR 2.22) after adjusting for the Agatston score.
Topics
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