Thoracic extra-coronary calcification for the prediction of stroke

The Multi-Ethnic Study of Atherosclerosis

Sina Kianoush, Mahmoud Al Rifai, Miguel Cainzos-Achirica, Mouaz H. Al-Mallah, Geoffrey H. Tison, Joseph Yeboah, Michael D. Miedema, Matthew A. Allison, Nathan D. Wong, Andrew P. DeFilippis, William Longstreth, Khurram Nasir, Matthew J. Budoff, Kunihiro Matsushita, Michael Blaha

Research output: Contribution to journalArticle

Abstract

Background and aims Atherosclerosis is a systemic disease. We examined whether the cumulative burden of thoracic extra-coronary calcification (ECC) improves prediction of stroke, transient ischemic attack (TIA), and stroke mortality beyond traditional risk factors and coronary artery calcium (CAC). Methods We followed a total of 6805 participants (mean age 62.1 ± 10.2 years, 47.2% male) from the Multi-Ethnic Study of Atherosclerosis (MESA) over a median of 12.1 years. The presence or absence of calcification at 4 thoracic ECC sites (mitral valve annulus, aortic valve, aortic root, and thoracic aorta) was determined from baseline cardiac-gated non-contrast CT scans. A multisite thoracic ECC score, ranging 0–4, was calculated by summing the 4 individual sites, which were treated as binary variables. Multivariable Cox proportional hazards regression models, controlled for traditional risk factors and CAC, were used to estimate hazard ratios for ischemic (primary endpoint) and hemorrhagic stroke, total stroke, TIA, and stroke mortality with increasing thoracic ECC. Results With an increasing number of thoracic ECC sites, there was a significant (p < 0.05) multivariable adjusted step-wise increase in the risk for ischemic stroke (n = 184), total stroke (n = 235), and TIA (n = 85), but not hemorrhagic stroke (n = 32) and stroke mortality (n = 42). Thoracic ECC increased the c-statistic and net reclassification index beyond traditional risk factors and CAC, but the results were not significant (p > 0.10). Conclusions Although multisite thoracic ECC is independently associated with ischemic stroke, total stroke, and TIA, the incremental predictive value of thoracic ECC beyond traditional risk factors and CAC appears to be minimal.

Original languageEnglish (US)
Pages (from-to)61-67
Number of pages7
JournalAtherosclerosis
Volume267
DOIs
StatePublished - Dec 1 2017

Fingerprint

Atherosclerosis
Thorax
Stroke
Transient Ischemic Attack
Coronary Vessels
Calcium
Mortality
Thoracic Aorta
Aortic Valve
Mitral Valve
Proportional Hazards Models

Keywords

  • Cardiovascular disease
  • Coronary artery calcium
  • Extracoronary calcium
  • Prevention
  • Risk prediction
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Thoracic extra-coronary calcification for the prediction of stroke : The Multi-Ethnic Study of Atherosclerosis. / Kianoush, Sina; Al Rifai, Mahmoud; Cainzos-Achirica, Miguel; Al-Mallah, Mouaz H.; Tison, Geoffrey H.; Yeboah, Joseph; Miedema, Michael D.; Allison, Matthew A.; Wong, Nathan D.; DeFilippis, Andrew P.; Longstreth, William; Nasir, Khurram; Budoff, Matthew J.; Matsushita, Kunihiro; Blaha, Michael.

In: Atherosclerosis, Vol. 267, 01.12.2017, p. 61-67.

Research output: Contribution to journalArticle

Kianoush, S, Al Rifai, M, Cainzos-Achirica, M, Al-Mallah, MH, Tison, GH, Yeboah, J, Miedema, MD, Allison, MA, Wong, ND, DeFilippis, AP, Longstreth, W, Nasir, K, Budoff, MJ, Matsushita, K & Blaha, M 2017, 'Thoracic extra-coronary calcification for the prediction of stroke: The Multi-Ethnic Study of Atherosclerosis', Atherosclerosis, vol. 267, pp. 61-67. https://doi.org/10.1016/j.atherosclerosis.2017.10.010
Kianoush, Sina ; Al Rifai, Mahmoud ; Cainzos-Achirica, Miguel ; Al-Mallah, Mouaz H. ; Tison, Geoffrey H. ; Yeboah, Joseph ; Miedema, Michael D. ; Allison, Matthew A. ; Wong, Nathan D. ; DeFilippis, Andrew P. ; Longstreth, William ; Nasir, Khurram ; Budoff, Matthew J. ; Matsushita, Kunihiro ; Blaha, Michael. / Thoracic extra-coronary calcification for the prediction of stroke : The Multi-Ethnic Study of Atherosclerosis. In: Atherosclerosis. 2017 ; Vol. 267. pp. 61-67.
@article{04abcbc8c00e471ebd7a319493b052cb,
title = "Thoracic extra-coronary calcification for the prediction of stroke: The Multi-Ethnic Study of Atherosclerosis",
abstract = "Background and aims Atherosclerosis is a systemic disease. We examined whether the cumulative burden of thoracic extra-coronary calcification (ECC) improves prediction of stroke, transient ischemic attack (TIA), and stroke mortality beyond traditional risk factors and coronary artery calcium (CAC). Methods We followed a total of 6805 participants (mean age 62.1 ± 10.2 years, 47.2{\%} male) from the Multi-Ethnic Study of Atherosclerosis (MESA) over a median of 12.1 years. The presence or absence of calcification at 4 thoracic ECC sites (mitral valve annulus, aortic valve, aortic root, and thoracic aorta) was determined from baseline cardiac-gated non-contrast CT scans. A multisite thoracic ECC score, ranging 0–4, was calculated by summing the 4 individual sites, which were treated as binary variables. Multivariable Cox proportional hazards regression models, controlled for traditional risk factors and CAC, were used to estimate hazard ratios for ischemic (primary endpoint) and hemorrhagic stroke, total stroke, TIA, and stroke mortality with increasing thoracic ECC. Results With an increasing number of thoracic ECC sites, there was a significant (p < 0.05) multivariable adjusted step-wise increase in the risk for ischemic stroke (n = 184), total stroke (n = 235), and TIA (n = 85), but not hemorrhagic stroke (n = 32) and stroke mortality (n = 42). Thoracic ECC increased the c-statistic and net reclassification index beyond traditional risk factors and CAC, but the results were not significant (p > 0.10). Conclusions Although multisite thoracic ECC is independently associated with ischemic stroke, total stroke, and TIA, the incremental predictive value of thoracic ECC beyond traditional risk factors and CAC appears to be minimal.",
keywords = "Cardiovascular disease, Coronary artery calcium, Extracoronary calcium, Prevention, Risk prediction, Stroke",
author = "Sina Kianoush and {Al Rifai}, Mahmoud and Miguel Cainzos-Achirica and Al-Mallah, {Mouaz H.} and Tison, {Geoffrey H.} and Joseph Yeboah and Miedema, {Michael D.} and Allison, {Matthew A.} and Wong, {Nathan D.} and DeFilippis, {Andrew P.} and William Longstreth and Khurram Nasir and Budoff, {Matthew J.} and Kunihiro Matsushita and Michael Blaha",
year = "2017",
month = "12",
day = "1",
doi = "10.1016/j.atherosclerosis.2017.10.010",
language = "English (US)",
volume = "267",
pages = "61--67",
journal = "Atherosclerosis",
issn = "0021-9150",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Thoracic extra-coronary calcification for the prediction of stroke

T2 - The Multi-Ethnic Study of Atherosclerosis

AU - Kianoush, Sina

AU - Al Rifai, Mahmoud

AU - Cainzos-Achirica, Miguel

AU - Al-Mallah, Mouaz H.

AU - Tison, Geoffrey H.

AU - Yeboah, Joseph

AU - Miedema, Michael D.

AU - Allison, Matthew A.

AU - Wong, Nathan D.

AU - DeFilippis, Andrew P.

AU - Longstreth, William

AU - Nasir, Khurram

AU - Budoff, Matthew J.

AU - Matsushita, Kunihiro

AU - Blaha, Michael

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background and aims Atherosclerosis is a systemic disease. We examined whether the cumulative burden of thoracic extra-coronary calcification (ECC) improves prediction of stroke, transient ischemic attack (TIA), and stroke mortality beyond traditional risk factors and coronary artery calcium (CAC). Methods We followed a total of 6805 participants (mean age 62.1 ± 10.2 years, 47.2% male) from the Multi-Ethnic Study of Atherosclerosis (MESA) over a median of 12.1 years. The presence or absence of calcification at 4 thoracic ECC sites (mitral valve annulus, aortic valve, aortic root, and thoracic aorta) was determined from baseline cardiac-gated non-contrast CT scans. A multisite thoracic ECC score, ranging 0–4, was calculated by summing the 4 individual sites, which were treated as binary variables. Multivariable Cox proportional hazards regression models, controlled for traditional risk factors and CAC, were used to estimate hazard ratios for ischemic (primary endpoint) and hemorrhagic stroke, total stroke, TIA, and stroke mortality with increasing thoracic ECC. Results With an increasing number of thoracic ECC sites, there was a significant (p < 0.05) multivariable adjusted step-wise increase in the risk for ischemic stroke (n = 184), total stroke (n = 235), and TIA (n = 85), but not hemorrhagic stroke (n = 32) and stroke mortality (n = 42). Thoracic ECC increased the c-statistic and net reclassification index beyond traditional risk factors and CAC, but the results were not significant (p > 0.10). Conclusions Although multisite thoracic ECC is independently associated with ischemic stroke, total stroke, and TIA, the incremental predictive value of thoracic ECC beyond traditional risk factors and CAC appears to be minimal.

AB - Background and aims Atherosclerosis is a systemic disease. We examined whether the cumulative burden of thoracic extra-coronary calcification (ECC) improves prediction of stroke, transient ischemic attack (TIA), and stroke mortality beyond traditional risk factors and coronary artery calcium (CAC). Methods We followed a total of 6805 participants (mean age 62.1 ± 10.2 years, 47.2% male) from the Multi-Ethnic Study of Atherosclerosis (MESA) over a median of 12.1 years. The presence or absence of calcification at 4 thoracic ECC sites (mitral valve annulus, aortic valve, aortic root, and thoracic aorta) was determined from baseline cardiac-gated non-contrast CT scans. A multisite thoracic ECC score, ranging 0–4, was calculated by summing the 4 individual sites, which were treated as binary variables. Multivariable Cox proportional hazards regression models, controlled for traditional risk factors and CAC, were used to estimate hazard ratios for ischemic (primary endpoint) and hemorrhagic stroke, total stroke, TIA, and stroke mortality with increasing thoracic ECC. Results With an increasing number of thoracic ECC sites, there was a significant (p < 0.05) multivariable adjusted step-wise increase in the risk for ischemic stroke (n = 184), total stroke (n = 235), and TIA (n = 85), but not hemorrhagic stroke (n = 32) and stroke mortality (n = 42). Thoracic ECC increased the c-statistic and net reclassification index beyond traditional risk factors and CAC, but the results were not significant (p > 0.10). Conclusions Although multisite thoracic ECC is independently associated with ischemic stroke, total stroke, and TIA, the incremental predictive value of thoracic ECC beyond traditional risk factors and CAC appears to be minimal.

KW - Cardiovascular disease

KW - Coronary artery calcium

KW - Extracoronary calcium

KW - Prevention

KW - Risk prediction

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=85032451138&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032451138&partnerID=8YFLogxK

U2 - 10.1016/j.atherosclerosis.2017.10.010

DO - 10.1016/j.atherosclerosis.2017.10.010

M3 - Article

VL - 267

SP - 61

EP - 67

JO - Atherosclerosis

JF - Atherosclerosis

SN - 0021-9150

ER -