Dataset Information

Long-Term All-Cause and Cause-Specific Mortality in Asymptomatic Patients With CAC ?1,000: Results From the CAC Consortium.

ABSTRACT:

Objectives

This study thoroughly explored the demographic and imaging characteristics, as well as the all-cause and cause-specific mortality risks of patients with a coronary artery calcium (CAC) score ?1,000 in the largest dataset of this population to date.

Background

CAC is commonly used to quantify cardiovascular risk. Current guidelines classify a CAC score of >300 or 400 as the highest risk group, yet little is known about the potentially unique imaging characteristics and mortality risk in individuals with a CAC score ?1,000.

Methods

A total of 66,636 asymptomatic adults were included from the CAC consortium, a large retrospective multicenter clinical cohort. Mean patient follow-up was 12.3 ± 3.9 years for patients with cardiovascular disease (CVD), coronary heart disease (CHD), cancer, and all-cause mortality. Multivariate Cox proportional hazards regression models adjusted for age, sex, and conventional risk factors were used to assess the relative mortality hazard of individuals with CAC ?1,000 compared with, first, a CAC reference of 0, and second, with patients with a CAC score of 400 to 999.

Results

There were 2,869 patients with CAC ?1,000 (86.3% male, mean 66.3 ± 9.7 years of age). Most patients with CAC ?1,000 had 4-vessel CAC (mean: 3.5 ± 0.6 vessels) and had greater total CAC area, higher mean CAC density, and more extracoronary calcium (79% with thoracic artery calcium, 46% with aortic valve calcium, and 21% with mitral valve calcium) than those with CAC scores of 400 to 999. After full adjustment, those with CAC ?1,000 had a 5.04- (95% confidence interval [CI]: 3.92 to 6.48), 6.79- (95% CI: 4.74 to 9.73), 1.55- (95% CI:1.23 to 1.95), and 2.89-fold (95% CI: 2.53 to 3.31) risk of CVD, CHD, cancer, and all-cause mortality, respectively, compared to those with CAC score of 0. The CAC ?1,000 group had a 1.71- (95% CI: 1.41 to 2.08), 1.84- (95% CI: 1.43 to 2.36), 1.36- (95% CI:1.07 to 1.73), and 1.51-fold (95% CI: 1.33 to 1.70) increased risk of CVD, CHD, cancer, and all-cause mortality compared to those with CAC scores 400 to 999. Graphic analysis of CAC ?1,000 patients revealed continued logarithmic increase in risk, with no clear evidence of a risk plateau.

Conclusions

Patients with extensive CAC (CAC ?1,000) represent a unique very high-risk phenotype with mortality outcomes commensurate with high-risk secondary prevention patients. Future guidelines should consider CAC ?1,000 patients to be a distinct risk group who may benefit from the most aggressive preventive therapy.

SUBMITTER: Peng AW

PROVIDER: S-EPMC6745300 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Long-Term All-Cause and Cause-Specific Mortality in Asymptomatic Patients With CAC ≥1,000: Results From the CAC Consortium.

Peng Allison W AW Mirbolouk Mohammadhassan M Orimoloye Olusola A OA Osei Albert D AD Dardari Zeina Z Dzaye Omar O Budoff Matthew J MJ Shaw Leslee L Miedema Michael D MD Rumberger John J Berman Daniel S DS Rozanski Alan A Al-Mallah Mouaz H MH Nasir Khurram K Blaha Michael J MJ

JACC. Cardiovascular imaging 20190315 1 Pt 1

<h4>Objectives</h4>This study thoroughly explored the demographic and imaging characteristics, as well as the all-cause and cause-specific mortality risks of patients with a coronary artery calcium (CAC) score ≥1,000 in the largest dataset of this population to date.<h4>Background</h4>CAC is commonly used to quantify cardiovascular risk. Current guidelines classify a CAC score of >300 or 400 as the highest risk group, yet little is known about the potentially unique imaging characteristics and m ...[more]

PMID: 31005541

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