Coronary Calcium Characteristics as Predictors of Major Adverse Cardiac Events in Symptomatic Patients: Insights From the CORE 320 Multinational Study

Mallory S. Lo-Kioeng-Shioe, Andrea L. Vavere, Armin Zadeh, Joanne D. Schuijf, Carlos E. Rochitte, Marcus Y. Chen, Matthias Rief, Klaus F. Kofoed, Melvin E. Clouse, Arthur J. Scholte, Julie M Miller, Aisha Betoko, Michael Blaha, Christopher Cox, Jaap W. Deckers, Joao Lima

Research output: Contribution to journalArticle

Abstract

Background The predictive value of coronary artery calcium ( CAC ) has been widely studied; however, little is known about specific characteristics of CAC that are most predictive. We aimed to determine the independent associations of Agatston score, CAC volume, CAC area, CAC mass, and CAC density score with major adverse cardiac events in patients with suspected coronary artery disease. Methods and Results A total of 379 symptomatic participants, aged 45 to 85 years, referred for invasive coronary angiography, who underwent coronary calcium scanning and computed tomography angiography as part of the CORE 320 (Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320 Detector Computed Tomography) study, were included. Agatston score, CAC volume, area, mass, and density were computed on noncontrast images. Stenosis measurements were made on contrast-enhanced images. The primary outcome of 2-year major adverse cardiac events (30 revascularizations [>182 days of index catheterization], 5 myocardial infarctions, 1 cardiac death, 9 hospitalizations, and 1 arrhythmia) occurred in 32 patients (8.4%). Associations were estimated using multivariable proportional means models. Median age was 62 (interquartile range, 56-68) years, 34% were women, and 56% were white. In separate models, the Agatston, volume, and density scores were all significantly associated with higher risk of major adverse cardiac events after adjustment for age, sex, race, and statin use; density was the strongest predictor in all CAC models. CAC density did not provide incremental value over Agatston score after adjustment for diameter stenosis, age, sex, and race. Conclusions In symptomatic patients, CAC density was the strongest independent predictor of major adverse cardiac events among CAC scores, but it did not provide incremental value beyond the Agatston score after adjustment for diameter stenosis.

Original languageEnglish (US)
Pages (from-to)e007201
JournalJournal of the American Heart Association
Volume8
Issue number6
DOIs
StatePublished - Mar 19 2019

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Coronary Vessels
Calcium
Pathologic Constriction
Coronary Angiography
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Myocardial Perfusion Imaging
Catheterization
Cardiac Arrhythmias
Coronary Artery Disease
Hospitalization
Myocardial Infarction
Tomography

Keywords

  • calcium density
  • cardiac computed tomography
  • coronary artery calcium
  • coronary artery disease
  • prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Coronary Calcium Characteristics as Predictors of Major Adverse Cardiac Events in Symptomatic Patients : Insights From the CORE 320 Multinational Study. / Lo-Kioeng-Shioe, Mallory S.; Vavere, Andrea L.; Zadeh, Armin; Schuijf, Joanne D.; Rochitte, Carlos E.; Chen, Marcus Y.; Rief, Matthias; Kofoed, Klaus F.; Clouse, Melvin E.; Scholte, Arthur J.; Miller, Julie M; Betoko, Aisha; Blaha, Michael; Cox, Christopher; Deckers, Jaap W.; Lima, Joao.

In: Journal of the American Heart Association, Vol. 8, No. 6, 19.03.2019, p. e007201.

Research output: Contribution to journalArticle

Lo-Kioeng-Shioe, Mallory S. ; Vavere, Andrea L. ; Zadeh, Armin ; Schuijf, Joanne D. ; Rochitte, Carlos E. ; Chen, Marcus Y. ; Rief, Matthias ; Kofoed, Klaus F. ; Clouse, Melvin E. ; Scholte, Arthur J. ; Miller, Julie M ; Betoko, Aisha ; Blaha, Michael ; Cox, Christopher ; Deckers, Jaap W. ; Lima, Joao. / Coronary Calcium Characteristics as Predictors of Major Adverse Cardiac Events in Symptomatic Patients : Insights From the CORE 320 Multinational Study. In: Journal of the American Heart Association. 2019 ; Vol. 8, No. 6. pp. e007201.
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abstract = "Background The predictive value of coronary artery calcium ( CAC ) has been widely studied; however, little is known about specific characteristics of CAC that are most predictive. We aimed to determine the independent associations of Agatston score, CAC volume, CAC area, CAC mass, and CAC density score with major adverse cardiac events in patients with suspected coronary artery disease. Methods and Results A total of 379 symptomatic participants, aged 45 to 85 years, referred for invasive coronary angiography, who underwent coronary calcium scanning and computed tomography angiography as part of the CORE 320 (Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320 Detector Computed Tomography) study, were included. Agatston score, CAC volume, area, mass, and density were computed on noncontrast images. Stenosis measurements were made on contrast-enhanced images. The primary outcome of 2-year major adverse cardiac events (30 revascularizations [>182 days of index catheterization], 5 myocardial infarctions, 1 cardiac death, 9 hospitalizations, and 1 arrhythmia) occurred in 32 patients (8.4{\%}). Associations were estimated using multivariable proportional means models. Median age was 62 (interquartile range, 56-68) years, 34{\%} were women, and 56{\%} were white. In separate models, the Agatston, volume, and density scores were all significantly associated with higher risk of major adverse cardiac events after adjustment for age, sex, race, and statin use; density was the strongest predictor in all CAC models. CAC density did not provide incremental value over Agatston score after adjustment for diameter stenosis, age, sex, and race. Conclusions In symptomatic patients, CAC density was the strongest independent predictor of major adverse cardiac events among CAC scores, but it did not provide incremental value beyond the Agatston score after adjustment for diameter stenosis.",
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author = "Lo-Kioeng-Shioe, {Mallory S.} and Vavere, {Andrea L.} and Armin Zadeh and Schuijf, {Joanne D.} and Rochitte, {Carlos E.} and Chen, {Marcus Y.} and Matthias Rief and Kofoed, {Klaus F.} and Clouse, {Melvin E.} and Scholte, {Arthur J.} and Miller, {Julie M} and Aisha Betoko and Michael Blaha and Christopher Cox and Deckers, {Jaap W.} and Joao Lima",
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T1 - Coronary Calcium Characteristics as Predictors of Major Adverse Cardiac Events in Symptomatic Patients

T2 - Insights From the CORE 320 Multinational Study

AU - Lo-Kioeng-Shioe, Mallory S.

AU - Vavere, Andrea L.

AU - Zadeh, Armin

AU - Schuijf, Joanne D.

AU - Rochitte, Carlos E.

AU - Chen, Marcus Y.

AU - Rief, Matthias

AU - Kofoed, Klaus F.

AU - Clouse, Melvin E.

AU - Scholte, Arthur J.

AU - Miller, Julie M

AU - Betoko, Aisha

AU - Blaha, Michael

AU - Cox, Christopher

AU - Deckers, Jaap W.

AU - Lima, Joao

PY - 2019/3/19

Y1 - 2019/3/19

N2 - Background The predictive value of coronary artery calcium ( CAC ) has been widely studied; however, little is known about specific characteristics of CAC that are most predictive. We aimed to determine the independent associations of Agatston score, CAC volume, CAC area, CAC mass, and CAC density score with major adverse cardiac events in patients with suspected coronary artery disease. Methods and Results A total of 379 symptomatic participants, aged 45 to 85 years, referred for invasive coronary angiography, who underwent coronary calcium scanning and computed tomography angiography as part of the CORE 320 (Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320 Detector Computed Tomography) study, were included. Agatston score, CAC volume, area, mass, and density were computed on noncontrast images. Stenosis measurements were made on contrast-enhanced images. The primary outcome of 2-year major adverse cardiac events (30 revascularizations [>182 days of index catheterization], 5 myocardial infarctions, 1 cardiac death, 9 hospitalizations, and 1 arrhythmia) occurred in 32 patients (8.4%). Associations were estimated using multivariable proportional means models. Median age was 62 (interquartile range, 56-68) years, 34% were women, and 56% were white. In separate models, the Agatston, volume, and density scores were all significantly associated with higher risk of major adverse cardiac events after adjustment for age, sex, race, and statin use; density was the strongest predictor in all CAC models. CAC density did not provide incremental value over Agatston score after adjustment for diameter stenosis, age, sex, and race. Conclusions In symptomatic patients, CAC density was the strongest independent predictor of major adverse cardiac events among CAC scores, but it did not provide incremental value beyond the Agatston score after adjustment for diameter stenosis.

AB - Background The predictive value of coronary artery calcium ( CAC ) has been widely studied; however, little is known about specific characteristics of CAC that are most predictive. We aimed to determine the independent associations of Agatston score, CAC volume, CAC area, CAC mass, and CAC density score with major adverse cardiac events in patients with suspected coronary artery disease. Methods and Results A total of 379 symptomatic participants, aged 45 to 85 years, referred for invasive coronary angiography, who underwent coronary calcium scanning and computed tomography angiography as part of the CORE 320 (Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320 Detector Computed Tomography) study, were included. Agatston score, CAC volume, area, mass, and density were computed on noncontrast images. Stenosis measurements were made on contrast-enhanced images. The primary outcome of 2-year major adverse cardiac events (30 revascularizations [>182 days of index catheterization], 5 myocardial infarctions, 1 cardiac death, 9 hospitalizations, and 1 arrhythmia) occurred in 32 patients (8.4%). Associations were estimated using multivariable proportional means models. Median age was 62 (interquartile range, 56-68) years, 34% were women, and 56% were white. In separate models, the Agatston, volume, and density scores were all significantly associated with higher risk of major adverse cardiac events after adjustment for age, sex, race, and statin use; density was the strongest predictor in all CAC models. CAC density did not provide incremental value over Agatston score after adjustment for diameter stenosis, age, sex, and race. Conclusions In symptomatic patients, CAC density was the strongest independent predictor of major adverse cardiac events among CAC scores, but it did not provide incremental value beyond the Agatston score after adjustment for diameter stenosis.

KW - calcium density

KW - cardiac computed tomography

KW - coronary artery calcium

KW - coronary artery disease

KW - prognosis

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