The presence of CAC in the proximal dominant coronary artery (HR 2.59; 95% CI 1.15-5.83; P=0.02) and increased number of arteries with CAC predicted major CHD events beyond traditional scores.
Cohort (n=1,268)
Does information on the distribution of coronary artery calcium improve prediction of incident major coronary heart disease compared to traditional Agatston score in subjects with CAC >0?
The distribution of coronary artery calcium, particularly in the proximal dominant artery, provides incremental prognostic value for major CHD events beyond the traditional Agatston score.
Hazard Ratio: 2.59 (95% CI 1.15–5.83)
p-value: p=0.02
Background— The presence and extent of coronary artery calcium (CAC) are associated with increased risk for cardiovascular events. We determined whether information on the distribution of CAC and coronary dominance as detected by cardiac computed tomography were incremental to traditional Agatston score (AS) in predicting incident major coronary heart disease (CHD). Methods and Results— We assessed total AS and the presence of CAC per coronary artery, per segment, and coronary dominance by computed tomography in participants from the offspring and third-generation cohorts of the Framingham Heart Study. The primary outcome was major CHD (myocardial infarction or CHD death). We performed multivariable Cox proportional hazards analysis and calculated relative integrated discrimination improvement. In 1268 subjects (mean age, 56.2±10.3 years, 63.2% men) with AS >0 and no history of major CHD, a total of 42 major CHD events occurred during median follow-up of 7.4 years. The number of coronary arteries with CAC (hazard ratio, 1.68 per artery; 95% confidence interval, 1.10–2.57; P =0.02) and the presence of CAC in the proximal dominant coronary artery (hazard ratio, 2.59; 95% confidence interval, 1.15–5.83; P =0.02) were associated with major CHD events after multivariable adjustment for Framingham risk score and categories of AS. In addition, measures of CAC distribution improved discriminatory capacity for major CHD events (relative integrated discrimination improvement, 0.14). Conclusions— Distribution of coronary atherosclerosis, especially CAC in the proximal dominant coronary artery and an increased number of coronary arteries with CAC, predict major CHD events independently of the traditional AS in community-dwelling men and women.
Ferencik et al. (Thu,) conducted a cohort in Coronary heart disease (n=1,268). Coronary artery calcium (CAC) distribution vs. Traditional Agatston score was evaluated on Major CHD (myocardial infarction or CHD death) (HR 2.59, 95% CI 1.15-5.83, p=0.02). The presence of CAC in the proximal dominant coronary artery (HR 2.59; 95% CI 1.15-5.83; P=0.02) and increased number of arteries with CAC predicted major CHD events beyond traditional scores.