Key result
Compared with a score of 0, higher coronary artery calcium burden was associated with a stepwise higher risk of sudden cardiac death, reaching an SHR of 4.9 (95% CI 2.6-9.9) for CAC >1,000.
Why the study?
Sudden cardiac death is a common initial manifestation of CHD, but its risk prediction remains elusive, and whether CAC improves risk stratification for incident SCD beyond ASCVD risk factors is unknown.
Does coronary artery calcium burden improve risk stratification for incident sudden cardiac death beyond traditional ASCVD risk factors in primary prevention patients?
Cohort (n=66,636)
Yes
Does coronary artery calcium burden improve risk stratification for incident sudden cardiac death beyond traditional ASCVD risk factors in primary prevention patients?
Hazard Ratio: 4.9 (95% CI 2.6–9.9)
p-value: p=<0.001
Higher coronary artery calcium burden is strongly associated with incident sudden cardiac death and improves risk prediction beyond traditional risk factors, particularly in low-to-intermediate risk primary prevention patients.
CAC may refine SCD prediction in low-intermediate ASCVD risk; leaves open whether it should guide interventions.
BACKGROUND: Coronary artery calcium (CAC) is a marker of plaque burden. Whether CAC improves risk stratification for incident sudden cardiac death (SCD) beyond atherosclerotic cardiovascular disease (ASCVD) risk factors is unknown. OBJECTIVES: SCD is a common initial manifestation of coronary heart disease (CHD); however, SCD risk prediction remains elusive. METHODS: The authors studied 66,636 primary prevention patients from the CAC Consortium. Multivariable competing risks regression and C-statistics were used to assess the association between CAC and SCD, adjusting for demographics and traditional risk factors. RESULTS: The mean age was 54.4 years, 33% were women, 11% were of non-White ethnicity, and 55% had CAC >0. A total of 211 SCD events (0.3%) were observed during a median follow-up of 10.6 years, 91% occurring among those with baseline CAC >0. Compared with CAC = 0, there was a stepwise higher risk (P trend < 0.001) in SCD for CAC 100 to 399 (subdistribution hazard ratio [SHR]: 2.8; 95% CI: 1.6-5.0), CAC 400 to 999 (SHR: 4.0; 95% CI: 2.2-7.3), and CAC >1,000 (SHR: 4.9; 95% CI: 2.6-9.9). CAC provided incremental improvements in the C-statistic for the prediction of SCD among individuals with a 10-year risk <7.5% (ΔC-statistic = +0.046; P = 0.02) and 7.5% to 20% (ΔC-statistic = +0.069; P = 0.003), which were larger when compared with persons with a 10-year risk >20% (ΔC-statistic = +0.01; P = 0.54). CONCLUSIONS: Higher CAC burden strongly associates with incident SCD beyond traditional risk factors, particularly among primary prevention patients with low-intermediate risk. SCD risk stratification can be useful in the early stages of CHD through the measurement of CAC, identifying patients most likely to benefit from further downstream testing.
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Razavi et al. (2022) conducted a cohort in Primary prevention of sudden cardiac death (n=66,636). Coronary artery calcium (CAC) burden vs. CAC = 0 was evaluated on Incident sudden cardiac death (SCD) (SHR 4.9, 95% CI 2.6-9.9, p=<0.001). Compared with a score of 0, higher coronary artery calcium burden was associated with a stepwise higher risk of sudden cardiac death, reaching an SHR of 4.9 (95% CI 2.6-9.9) for CAC >1,000.
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