All-cause mortality in asymptomatic persons with extensive Agatston scores above 1000

Jaideep Patel, Michael Blaha, John W. McEvoy, Sadia Qadir, Rajesh Tota-Maharaj, Leslee J. Shaw, John A. Rumberger, Tracy Q. Callister, Daniel S. Berman, James K. Min, Paolo Raggi, Arthur A. Agatston, Roger S Blumenthal, Matthew J. Budoff, Khurram Nasir

Research output: Contribution to journalArticle

Abstract

Background: Risk assessment in the extensive calcified plaque phenotype has been limited by small sample size. Objective: We studied all-cause mortality rates among asymptomatic patients with markedly elevated Agatston scores >1000. Methods: We studied a clinical cohort of 44,052 asymptomatic patients referred for coronary calcium scans. Mean follow-up was 5.6years (range, 1-13years). All-cause mortality rates were calculated after stratifying by Agatston score (0, 1-1000, 1001-1500, 1500-2000, and >2000). A multivariable Cox regression model adjusting for self-reported traditional risk factors was created to assess the relative mortality hazard of Agatston scores 1001 to 1500, 1501 to 2000, and >2000. With the use of post-estimation modeling, we assessed for the presence of an upper threshold of risk with high Agatston scores. Results: A total of 1593 patients (4% of total population) had Agatston score > 1000. There was a continuous graded decrease in estimated 10-year survival across increasing Agatston score, continuing when Agatston score > 1000 (Agatston score 1001-1500, 78%; Agatston score 1501-2000, 74%; Agatston score > 2000, 51%). After multivariable adjustment, Agatston scores 1001 to 1500, 1501 to 2000, and >2000 were associated with an 8.05-, 7.45-, and 13.26-fold greater mortality risk, respectively, than for Agatston score of 0. Compared with Agatston score 1001 to 1500, Agatston score 1501 to 2000 had a similar all-cause mortality risk, whereas Agatston score > 2000 had an increased relative risk (Agatston score 1501-2000: hazard ratio [HR], 1.01 [95% CI, 0.67-1.51]; Agatston score > 2000: HR, 1.79 [95% CI, 1.30-2.46]). Graphical assessment of the predicted survival model suggests no upper threshold for risk associated with calcified plaque in coronary arteries. Conclusion: Increasing calcified plaque in coronary arteries continues to predict a graded decrease in survival among patients with extensive Agatston score > 1000 with no apparent upper threshold.

Original languageEnglish (US)
Pages (from-to)26-32
Number of pages7
JournalJournal of Cardiovascular Computed Tomography
Volume8
Issue number1
DOIs
StatePublished - Jan 2014

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Mortality
Survival
Coronary Vessels
Proportional Hazards Models
Sample Size
Calcium
Phenotype
Population

Keywords

  • Agatston score > 1000
  • Calcified plaque in coronary arteries paradox
  • Coronary artery calcium
  • Stable plaque

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

All-cause mortality in asymptomatic persons with extensive Agatston scores above 1000. / Patel, Jaideep; Blaha, Michael; McEvoy, John W.; Qadir, Sadia; Tota-Maharaj, Rajesh; Shaw, Leslee J.; Rumberger, John A.; Callister, Tracy Q.; Berman, Daniel S.; Min, James K.; Raggi, Paolo; Agatston, Arthur A.; Blumenthal, Roger S; Budoff, Matthew J.; Nasir, Khurram.

In: Journal of Cardiovascular Computed Tomography, Vol. 8, No. 1, 01.2014, p. 26-32.

Research output: Contribution to journalArticle

Patel, J, Blaha, M, McEvoy, JW, Qadir, S, Tota-Maharaj, R, Shaw, LJ, Rumberger, JA, Callister, TQ, Berman, DS, Min, JK, Raggi, P, Agatston, AA, Blumenthal, RS, Budoff, MJ & Nasir, K 2014, 'All-cause mortality in asymptomatic persons with extensive Agatston scores above 1000', Journal of Cardiovascular Computed Tomography, vol. 8, no. 1, pp. 26-32. https://doi.org/10.1016/j.jcct.2013.12.002
Patel, Jaideep ; Blaha, Michael ; McEvoy, John W. ; Qadir, Sadia ; Tota-Maharaj, Rajesh ; Shaw, Leslee J. ; Rumberger, John A. ; Callister, Tracy Q. ; Berman, Daniel S. ; Min, James K. ; Raggi, Paolo ; Agatston, Arthur A. ; Blumenthal, Roger S ; Budoff, Matthew J. ; Nasir, Khurram. / All-cause mortality in asymptomatic persons with extensive Agatston scores above 1000. In: Journal of Cardiovascular Computed Tomography. 2014 ; Vol. 8, No. 1. pp. 26-32.
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abstract = "Background: Risk assessment in the extensive calcified plaque phenotype has been limited by small sample size. Objective: We studied all-cause mortality rates among asymptomatic patients with markedly elevated Agatston scores >1000. Methods: We studied a clinical cohort of 44,052 asymptomatic patients referred for coronary calcium scans. Mean follow-up was 5.6years (range, 1-13years). All-cause mortality rates were calculated after stratifying by Agatston score (0, 1-1000, 1001-1500, 1500-2000, and >2000). A multivariable Cox regression model adjusting for self-reported traditional risk factors was created to assess the relative mortality hazard of Agatston scores 1001 to 1500, 1501 to 2000, and >2000. With the use of post-estimation modeling, we assessed for the presence of an upper threshold of risk with high Agatston scores. Results: A total of 1593 patients (4{\%} of total population) had Agatston score > 1000. There was a continuous graded decrease in estimated 10-year survival across increasing Agatston score, continuing when Agatston score > 1000 (Agatston score 1001-1500, 78{\%}; Agatston score 1501-2000, 74{\%}; Agatston score > 2000, 51{\%}). After multivariable adjustment, Agatston scores 1001 to 1500, 1501 to 2000, and >2000 were associated with an 8.05-, 7.45-, and 13.26-fold greater mortality risk, respectively, than for Agatston score of 0. Compared with Agatston score 1001 to 1500, Agatston score 1501 to 2000 had a similar all-cause mortality risk, whereas Agatston score > 2000 had an increased relative risk (Agatston score 1501-2000: hazard ratio [HR], 1.01 [95{\%} CI, 0.67-1.51]; Agatston score > 2000: HR, 1.79 [95{\%} CI, 1.30-2.46]). Graphical assessment of the predicted survival model suggests no upper threshold for risk associated with calcified plaque in coronary arteries. Conclusion: Increasing calcified plaque in coronary arteries continues to predict a graded decrease in survival among patients with extensive Agatston score > 1000 with no apparent upper threshold.",
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T1 - All-cause mortality in asymptomatic persons with extensive Agatston scores above 1000

AU - Patel, Jaideep

AU - Blaha, Michael

AU - McEvoy, John W.

AU - Qadir, Sadia

AU - Tota-Maharaj, Rajesh

AU - Shaw, Leslee J.

AU - Rumberger, John A.

AU - Callister, Tracy Q.

AU - Berman, Daniel S.

AU - Min, James K.

AU - Raggi, Paolo

AU - Agatston, Arthur A.

AU - Blumenthal, Roger S

AU - Budoff, Matthew J.

AU - Nasir, Khurram

PY - 2014/1

Y1 - 2014/1

N2 - Background: Risk assessment in the extensive calcified plaque phenotype has been limited by small sample size. Objective: We studied all-cause mortality rates among asymptomatic patients with markedly elevated Agatston scores >1000. Methods: We studied a clinical cohort of 44,052 asymptomatic patients referred for coronary calcium scans. Mean follow-up was 5.6years (range, 1-13years). All-cause mortality rates were calculated after stratifying by Agatston score (0, 1-1000, 1001-1500, 1500-2000, and >2000). A multivariable Cox regression model adjusting for self-reported traditional risk factors was created to assess the relative mortality hazard of Agatston scores 1001 to 1500, 1501 to 2000, and >2000. With the use of post-estimation modeling, we assessed for the presence of an upper threshold of risk with high Agatston scores. Results: A total of 1593 patients (4% of total population) had Agatston score > 1000. There was a continuous graded decrease in estimated 10-year survival across increasing Agatston score, continuing when Agatston score > 1000 (Agatston score 1001-1500, 78%; Agatston score 1501-2000, 74%; Agatston score > 2000, 51%). After multivariable adjustment, Agatston scores 1001 to 1500, 1501 to 2000, and >2000 were associated with an 8.05-, 7.45-, and 13.26-fold greater mortality risk, respectively, than for Agatston score of 0. Compared with Agatston score 1001 to 1500, Agatston score 1501 to 2000 had a similar all-cause mortality risk, whereas Agatston score > 2000 had an increased relative risk (Agatston score 1501-2000: hazard ratio [HR], 1.01 [95% CI, 0.67-1.51]; Agatston score > 2000: HR, 1.79 [95% CI, 1.30-2.46]). Graphical assessment of the predicted survival model suggests no upper threshold for risk associated with calcified plaque in coronary arteries. Conclusion: Increasing calcified plaque in coronary arteries continues to predict a graded decrease in survival among patients with extensive Agatston score > 1000 with no apparent upper threshold.

AB - Background: Risk assessment in the extensive calcified plaque phenotype has been limited by small sample size. Objective: We studied all-cause mortality rates among asymptomatic patients with markedly elevated Agatston scores >1000. Methods: We studied a clinical cohort of 44,052 asymptomatic patients referred for coronary calcium scans. Mean follow-up was 5.6years (range, 1-13years). All-cause mortality rates were calculated after stratifying by Agatston score (0, 1-1000, 1001-1500, 1500-2000, and >2000). A multivariable Cox regression model adjusting for self-reported traditional risk factors was created to assess the relative mortality hazard of Agatston scores 1001 to 1500, 1501 to 2000, and >2000. With the use of post-estimation modeling, we assessed for the presence of an upper threshold of risk with high Agatston scores. Results: A total of 1593 patients (4% of total population) had Agatston score > 1000. There was a continuous graded decrease in estimated 10-year survival across increasing Agatston score, continuing when Agatston score > 1000 (Agatston score 1001-1500, 78%; Agatston score 1501-2000, 74%; Agatston score > 2000, 51%). After multivariable adjustment, Agatston scores 1001 to 1500, 1501 to 2000, and >2000 were associated with an 8.05-, 7.45-, and 13.26-fold greater mortality risk, respectively, than for Agatston score of 0. Compared with Agatston score 1001 to 1500, Agatston score 1501 to 2000 had a similar all-cause mortality risk, whereas Agatston score > 2000 had an increased relative risk (Agatston score 1501-2000: hazard ratio [HR], 1.01 [95% CI, 0.67-1.51]; Agatston score > 2000: HR, 1.79 [95% CI, 1.30-2.46]). Graphical assessment of the predicted survival model suggests no upper threshold for risk associated with calcified plaque in coronary arteries. Conclusion: Increasing calcified plaque in coronary arteries continues to predict a graded decrease in survival among patients with extensive Agatston score > 1000 with no apparent upper threshold.

KW - Agatston score > 1000

KW - Calcified plaque in coronary arteries paradox

KW - Coronary artery calcium

KW - Stable plaque

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