The association between left main coronary artery calcium and cardiovascular-specific and total mortality

The Coronary Artery Calcium Consortium

Steven J. Lahti, David I. Feldman, Zeina Dardari, Mohammadhassan Mirbolouk, Olusola A. Orimoloye, Albert D. Osei, Garth Graham, John Rumberger, Leslee Shaw, Matthew J. Budoff, Alan Rozanski, Michael D. Miedema, Mouaz H. Al-Mallah, Dan Berman, Khurram Nasir, Michael Blaha

Research output: Contribution to journalArticle

Abstract

Background and aims: Left main (LM) coronary artery disease is associated with greater myocardial infarction-related mortality, however, coronary artery calcium (CAC) scoring does not account for disease location. We explored whether LM CAC predicts excess mortality in asymptomatic adults. Methods: Cause-specific cardiovascular and all-cause mortality was studied in 28,147 asymptomatic patients with non-zero CAC scores in the CAC Consortium. Multivariate regression was performed to evaluate if the presence and burden of LM CAC predict mortality after adjustment for clinical risk factors and the Agatston CAC score. We further analyzed the per-unit hazard associated with LM CAC in comparison to CAC in other arteries. Results: The study population had mean age of 58.3 ± 10 years and CAC score of 301 ± 631. LM CAC was present in 21.7% of the cases. During 312,398 patient-years of follow-up, 1,907 deaths were observed. LM CAC was associated with an increased burden of clinical risk factors and total CAC, and was independently predictive of increased hazard for all-cause (HR 1.2 [1.1, 1.3]) and cardiovascular disease death (HR 1.3 [1.1, 1.5]). The hazard for death increased proportionate to the percentage of CAC localized to the LM. On a per-100 Agatston unit basis, LM CAC was associated with a 6–9% incremental hazard for death beyond knowledge of CAC in other arteries. Conclusions: The presence and high burden of left main CAC are independently associated with a 20–30% greater hazard for cardiovascular and total mortality in asymptomatic adults, arguing that LM CAC should be routinely noted in CAC score reports when present.

Original languageEnglish (US)
JournalAtherosclerosis
DOIs
StatePublished - Jan 1 2019

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Coronary Vessels
Calcium
Mortality
Arteries
Coronary Artery Disease
Cardiovascular Diseases

Keywords

  • Cardiovascular risk
  • Coronary artery calcium
  • Left-main atherosclerosis
  • Screening

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The association between left main coronary artery calcium and cardiovascular-specific and total mortality : The Coronary Artery Calcium Consortium. / Lahti, Steven J.; Feldman, David I.; Dardari, Zeina; Mirbolouk, Mohammadhassan; Orimoloye, Olusola A.; Osei, Albert D.; Graham, Garth; Rumberger, John; Shaw, Leslee; Budoff, Matthew J.; Rozanski, Alan; Miedema, Michael D.; Al-Mallah, Mouaz H.; Berman, Dan; Nasir, Khurram; Blaha, Michael.

In: Atherosclerosis, 01.01.2019.

Research output: Contribution to journalArticle

Lahti, SJ, Feldman, DI, Dardari, Z, Mirbolouk, M, Orimoloye, OA, Osei, AD, Graham, G, Rumberger, J, Shaw, L, Budoff, MJ, Rozanski, A, Miedema, MD, Al-Mallah, MH, Berman, D, Nasir, K & Blaha, M 2019, 'The association between left main coronary artery calcium and cardiovascular-specific and total mortality: The Coronary Artery Calcium Consortium', Atherosclerosis. https://doi.org/10.1016/j.atherosclerosis.2019.03.015
Lahti, Steven J. ; Feldman, David I. ; Dardari, Zeina ; Mirbolouk, Mohammadhassan ; Orimoloye, Olusola A. ; Osei, Albert D. ; Graham, Garth ; Rumberger, John ; Shaw, Leslee ; Budoff, Matthew J. ; Rozanski, Alan ; Miedema, Michael D. ; Al-Mallah, Mouaz H. ; Berman, Dan ; Nasir, Khurram ; Blaha, Michael. / The association between left main coronary artery calcium and cardiovascular-specific and total mortality : The Coronary Artery Calcium Consortium. In: Atherosclerosis. 2019.
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abstract = "Background and aims: Left main (LM) coronary artery disease is associated with greater myocardial infarction-related mortality, however, coronary artery calcium (CAC) scoring does not account for disease location. We explored whether LM CAC predicts excess mortality in asymptomatic adults. Methods: Cause-specific cardiovascular and all-cause mortality was studied in 28,147 asymptomatic patients with non-zero CAC scores in the CAC Consortium. Multivariate regression was performed to evaluate if the presence and burden of LM CAC predict mortality after adjustment for clinical risk factors and the Agatston CAC score. We further analyzed the per-unit hazard associated with LM CAC in comparison to CAC in other arteries. Results: The study population had mean age of 58.3 ± 10 years and CAC score of 301 ± 631. LM CAC was present in 21.7{\%} of the cases. During 312,398 patient-years of follow-up, 1,907 deaths were observed. LM CAC was associated with an increased burden of clinical risk factors and total CAC, and was independently predictive of increased hazard for all-cause (HR 1.2 [1.1, 1.3]) and cardiovascular disease death (HR 1.3 [1.1, 1.5]). The hazard for death increased proportionate to the percentage of CAC localized to the LM. On a per-100 Agatston unit basis, LM CAC was associated with a 6–9{\%} incremental hazard for death beyond knowledge of CAC in other arteries. Conclusions: The presence and high burden of left main CAC are independently associated with a 20–30{\%} greater hazard for cardiovascular and total mortality in asymptomatic adults, arguing that LM CAC should be routinely noted in CAC score reports when present.",
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T1 - The association between left main coronary artery calcium and cardiovascular-specific and total mortality

T2 - The Coronary Artery Calcium Consortium

AU - Lahti, Steven J.

AU - Feldman, David I.

AU - Dardari, Zeina

AU - Mirbolouk, Mohammadhassan

AU - Orimoloye, Olusola A.

AU - Osei, Albert D.

AU - Graham, Garth

AU - Rumberger, John

AU - Shaw, Leslee

AU - Budoff, Matthew J.

AU - Rozanski, Alan

AU - Miedema, Michael D.

AU - Al-Mallah, Mouaz H.

AU - Berman, Dan

AU - Nasir, Khurram

AU - Blaha, Michael

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background and aims: Left main (LM) coronary artery disease is associated with greater myocardial infarction-related mortality, however, coronary artery calcium (CAC) scoring does not account for disease location. We explored whether LM CAC predicts excess mortality in asymptomatic adults. Methods: Cause-specific cardiovascular and all-cause mortality was studied in 28,147 asymptomatic patients with non-zero CAC scores in the CAC Consortium. Multivariate regression was performed to evaluate if the presence and burden of LM CAC predict mortality after adjustment for clinical risk factors and the Agatston CAC score. We further analyzed the per-unit hazard associated with LM CAC in comparison to CAC in other arteries. Results: The study population had mean age of 58.3 ± 10 years and CAC score of 301 ± 631. LM CAC was present in 21.7% of the cases. During 312,398 patient-years of follow-up, 1,907 deaths were observed. LM CAC was associated with an increased burden of clinical risk factors and total CAC, and was independently predictive of increased hazard for all-cause (HR 1.2 [1.1, 1.3]) and cardiovascular disease death (HR 1.3 [1.1, 1.5]). The hazard for death increased proportionate to the percentage of CAC localized to the LM. On a per-100 Agatston unit basis, LM CAC was associated with a 6–9% incremental hazard for death beyond knowledge of CAC in other arteries. Conclusions: The presence and high burden of left main CAC are independently associated with a 20–30% greater hazard for cardiovascular and total mortality in asymptomatic adults, arguing that LM CAC should be routinely noted in CAC score reports when present.

AB - Background and aims: Left main (LM) coronary artery disease is associated with greater myocardial infarction-related mortality, however, coronary artery calcium (CAC) scoring does not account for disease location. We explored whether LM CAC predicts excess mortality in asymptomatic adults. Methods: Cause-specific cardiovascular and all-cause mortality was studied in 28,147 asymptomatic patients with non-zero CAC scores in the CAC Consortium. Multivariate regression was performed to evaluate if the presence and burden of LM CAC predict mortality after adjustment for clinical risk factors and the Agatston CAC score. We further analyzed the per-unit hazard associated with LM CAC in comparison to CAC in other arteries. Results: The study population had mean age of 58.3 ± 10 years and CAC score of 301 ± 631. LM CAC was present in 21.7% of the cases. During 312,398 patient-years of follow-up, 1,907 deaths were observed. LM CAC was associated with an increased burden of clinical risk factors and total CAC, and was independently predictive of increased hazard for all-cause (HR 1.2 [1.1, 1.3]) and cardiovascular disease death (HR 1.3 [1.1, 1.5]). The hazard for death increased proportionate to the percentage of CAC localized to the LM. On a per-100 Agatston unit basis, LM CAC was associated with a 6–9% incremental hazard for death beyond knowledge of CAC in other arteries. Conclusions: The presence and high burden of left main CAC are independently associated with a 20–30% greater hazard for cardiovascular and total mortality in asymptomatic adults, arguing that LM CAC should be routinely noted in CAC score reports when present.

KW - Cardiovascular risk

KW - Coronary artery calcium

KW - Left-main atherosclerosis

KW - Screening

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