Validation of the Coronary Artery Calcium Data and Reporting System (CAC-DRS): Dual importance of CAC score and CAC distribution from the Coronary Artery Calcium (CAC) consortium

Omar Dzaye, Ramzi Dudum, Mohammadhassan Mirbolouk, Olusola A. Orimoloye, Albert D. Osei, Zeina A. Dardari, Daniel S. Berman, Michael D. Miedema, Leslee Shaw, Alan Rozanski, Matthias Holdhoff, Khurram Nasir, John A. Rumberger, Matthew J. Budoff, Mouaz H. Al-Mallah, Ron Blankstein, Michael Blaha

Research output: Contribution to journalArticle

Abstract

Background: The Coronary Artery Calcium Data and Reporting System (CAC-DRS), which takes into account the Agatston score category (A) and the number of calcified vessels (N) has not yet been validated in terms of its prognostic significance. Methods: We included 54,678 patients from the CAC Consortium, a large retrospective clinical cohort of asymptomatic individuals free of baseline cardiovascular disease (CVD). CAC-DRS groups were derived from routine, cardiac-gated CAC scans. Cox proportional hazards regression models, adjusted for traditional CVD risk factors, were used to assess the association between CAC-DRS groups and CHD, CVD, and all-cause mortality. CAC-DRS was then compared to CAC score groups and regional CAC distribution using area under the curve (AUC) analysis. Results: The study population had a mean age of 54.2 ± 10.7, 34.4% female, and mean ASCVD score 7.3% ± 9.0. Over a mean follow-up of 12 ± 4 years, a total of 2,469 deaths (including 398 CHD deaths and 762 CVD deaths) were recorded. There was a graded risk for CHD, CVD and all-cause mortality with increasing CAC-DRS groups ranging from an all-cause mortality rate of 1.2 per 1,000 person-years for A0 to 15.4 per 1,000 person-years for A3/N4. In multivariable-adjusted models, those with CAC-DRS A3/N4 had significantly higher risk for CHD mortality (HR 5.9 (95% CI 3.6–9.9), CVD mortality (HR4.0 (95% CI 2.8–5.7), and all-cause mortality a (HR 2.5 (95% CI 2.1–3.0) compared to CAC-DRS A0. CAC-DRS had higher AUC than CAC score groups (0.762 vs 0.754, P < 0.001) and CAC distribution (0.762 vs 0.748, P < 0.001). Conclusion: The CAC-DRS system, combining the Agatston score and the number of vessels with CAC provides better stratification of risk for CHD, CVD, and all-cause death than the Agatston score alone. These prognostic data strongly support new SCCT guidelines recommending the use CAC-DRS scoring.

Original languageEnglish (US)
JournalJournal of cardiovascular computed tomography
DOIs
StatePublished - Jan 1 2019

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Information Systems
Coronary Vessels
Research Design
Calcium
Cardiovascular Diseases
Mortality
Area Under Curve
Proportional Hazards Models
Cause of Death

Keywords

  • Computed tomography
  • Coronary artery calcium
  • Coronary artery calcium data and reporting system

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Validation of the Coronary Artery Calcium Data and Reporting System (CAC-DRS) : Dual importance of CAC score and CAC distribution from the Coronary Artery Calcium (CAC) consortium. / Dzaye, Omar; Dudum, Ramzi; Mirbolouk, Mohammadhassan; Orimoloye, Olusola A.; Osei, Albert D.; Dardari, Zeina A.; Berman, Daniel S.; Miedema, Michael D.; Shaw, Leslee; Rozanski, Alan; Holdhoff, Matthias; Nasir, Khurram; Rumberger, John A.; Budoff, Matthew J.; Al-Mallah, Mouaz H.; Blankstein, Ron; Blaha, Michael.

In: Journal of cardiovascular computed tomography, 01.01.2019.

Research output: Contribution to journalArticle

Dzaye, O, Dudum, R, Mirbolouk, M, Orimoloye, OA, Osei, AD, Dardari, ZA, Berman, DS, Miedema, MD, Shaw, L, Rozanski, A, Holdhoff, M, Nasir, K, Rumberger, JA, Budoff, MJ, Al-Mallah, MH, Blankstein, R & Blaha, M 2019, 'Validation of the Coronary Artery Calcium Data and Reporting System (CAC-DRS): Dual importance of CAC score and CAC distribution from the Coronary Artery Calcium (CAC) consortium', Journal of cardiovascular computed tomography. https://doi.org/10.1016/j.jcct.2019.03.011
Dzaye, Omar ; Dudum, Ramzi ; Mirbolouk, Mohammadhassan ; Orimoloye, Olusola A. ; Osei, Albert D. ; Dardari, Zeina A. ; Berman, Daniel S. ; Miedema, Michael D. ; Shaw, Leslee ; Rozanski, Alan ; Holdhoff, Matthias ; Nasir, Khurram ; Rumberger, John A. ; Budoff, Matthew J. ; Al-Mallah, Mouaz H. ; Blankstein, Ron ; Blaha, Michael. / Validation of the Coronary Artery Calcium Data and Reporting System (CAC-DRS) : Dual importance of CAC score and CAC distribution from the Coronary Artery Calcium (CAC) consortium. In: Journal of cardiovascular computed tomography. 2019.
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title = "Validation of the Coronary Artery Calcium Data and Reporting System (CAC-DRS): Dual importance of CAC score and CAC distribution from the Coronary Artery Calcium (CAC) consortium",
abstract = "Background: The Coronary Artery Calcium Data and Reporting System (CAC-DRS), which takes into account the Agatston score category (A) and the number of calcified vessels (N) has not yet been validated in terms of its prognostic significance. Methods: We included 54,678 patients from the CAC Consortium, a large retrospective clinical cohort of asymptomatic individuals free of baseline cardiovascular disease (CVD). CAC-DRS groups were derived from routine, cardiac-gated CAC scans. Cox proportional hazards regression models, adjusted for traditional CVD risk factors, were used to assess the association between CAC-DRS groups and CHD, CVD, and all-cause mortality. CAC-DRS was then compared to CAC score groups and regional CAC distribution using area under the curve (AUC) analysis. Results: The study population had a mean age of 54.2 ± 10.7, 34.4{\%} female, and mean ASCVD score 7.3{\%} ± 9.0. Over a mean follow-up of 12 ± 4 years, a total of 2,469 deaths (including 398 CHD deaths and 762 CVD deaths) were recorded. There was a graded risk for CHD, CVD and all-cause mortality with increasing CAC-DRS groups ranging from an all-cause mortality rate of 1.2 per 1,000 person-years for A0 to 15.4 per 1,000 person-years for A3/N4. In multivariable-adjusted models, those with CAC-DRS A3/N4 had significantly higher risk for CHD mortality (HR 5.9 (95{\%} CI 3.6–9.9), CVD mortality (HR4.0 (95{\%} CI 2.8–5.7), and all-cause mortality a (HR 2.5 (95{\%} CI 2.1–3.0) compared to CAC-DRS A0. CAC-DRS had higher AUC than CAC score groups (0.762 vs 0.754, P < 0.001) and CAC distribution (0.762 vs 0.748, P < 0.001). Conclusion: The CAC-DRS system, combining the Agatston score and the number of vessels with CAC provides better stratification of risk for CHD, CVD, and all-cause death than the Agatston score alone. These prognostic data strongly support new SCCT guidelines recommending the use CAC-DRS scoring.",
keywords = "Computed tomography, Coronary artery calcium, Coronary artery calcium data and reporting system",
author = "Omar Dzaye and Ramzi Dudum and Mohammadhassan Mirbolouk and Orimoloye, {Olusola A.} and Osei, {Albert D.} and Dardari, {Zeina A.} and Berman, {Daniel S.} and Miedema, {Michael D.} and Leslee Shaw and Alan Rozanski and Matthias Holdhoff and Khurram Nasir and Rumberger, {John A.} and Budoff, {Matthew J.} and Al-Mallah, {Mouaz H.} and Ron Blankstein and Michael Blaha",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jcct.2019.03.011",
language = "English (US)",
journal = "Journal of Cardiovascular Computed Tomography",
issn = "1934-5925",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Validation of the Coronary Artery Calcium Data and Reporting System (CAC-DRS)

T2 - Dual importance of CAC score and CAC distribution from the Coronary Artery Calcium (CAC) consortium

AU - Dzaye, Omar

AU - Dudum, Ramzi

AU - Mirbolouk, Mohammadhassan

AU - Orimoloye, Olusola A.

AU - Osei, Albert D.

AU - Dardari, Zeina A.

AU - Berman, Daniel S.

AU - Miedema, Michael D.

AU - Shaw, Leslee

AU - Rozanski, Alan

AU - Holdhoff, Matthias

AU - Nasir, Khurram

AU - Rumberger, John A.

AU - Budoff, Matthew J.

AU - Al-Mallah, Mouaz H.

AU - Blankstein, Ron

AU - Blaha, Michael

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: The Coronary Artery Calcium Data and Reporting System (CAC-DRS), which takes into account the Agatston score category (A) and the number of calcified vessels (N) has not yet been validated in terms of its prognostic significance. Methods: We included 54,678 patients from the CAC Consortium, a large retrospective clinical cohort of asymptomatic individuals free of baseline cardiovascular disease (CVD). CAC-DRS groups were derived from routine, cardiac-gated CAC scans. Cox proportional hazards regression models, adjusted for traditional CVD risk factors, were used to assess the association between CAC-DRS groups and CHD, CVD, and all-cause mortality. CAC-DRS was then compared to CAC score groups and regional CAC distribution using area under the curve (AUC) analysis. Results: The study population had a mean age of 54.2 ± 10.7, 34.4% female, and mean ASCVD score 7.3% ± 9.0. Over a mean follow-up of 12 ± 4 years, a total of 2,469 deaths (including 398 CHD deaths and 762 CVD deaths) were recorded. There was a graded risk for CHD, CVD and all-cause mortality with increasing CAC-DRS groups ranging from an all-cause mortality rate of 1.2 per 1,000 person-years for A0 to 15.4 per 1,000 person-years for A3/N4. In multivariable-adjusted models, those with CAC-DRS A3/N4 had significantly higher risk for CHD mortality (HR 5.9 (95% CI 3.6–9.9), CVD mortality (HR4.0 (95% CI 2.8–5.7), and all-cause mortality a (HR 2.5 (95% CI 2.1–3.0) compared to CAC-DRS A0. CAC-DRS had higher AUC than CAC score groups (0.762 vs 0.754, P < 0.001) and CAC distribution (0.762 vs 0.748, P < 0.001). Conclusion: The CAC-DRS system, combining the Agatston score and the number of vessels with CAC provides better stratification of risk for CHD, CVD, and all-cause death than the Agatston score alone. These prognostic data strongly support new SCCT guidelines recommending the use CAC-DRS scoring.

AB - Background: The Coronary Artery Calcium Data and Reporting System (CAC-DRS), which takes into account the Agatston score category (A) and the number of calcified vessels (N) has not yet been validated in terms of its prognostic significance. Methods: We included 54,678 patients from the CAC Consortium, a large retrospective clinical cohort of asymptomatic individuals free of baseline cardiovascular disease (CVD). CAC-DRS groups were derived from routine, cardiac-gated CAC scans. Cox proportional hazards regression models, adjusted for traditional CVD risk factors, were used to assess the association between CAC-DRS groups and CHD, CVD, and all-cause mortality. CAC-DRS was then compared to CAC score groups and regional CAC distribution using area under the curve (AUC) analysis. Results: The study population had a mean age of 54.2 ± 10.7, 34.4% female, and mean ASCVD score 7.3% ± 9.0. Over a mean follow-up of 12 ± 4 years, a total of 2,469 deaths (including 398 CHD deaths and 762 CVD deaths) were recorded. There was a graded risk for CHD, CVD and all-cause mortality with increasing CAC-DRS groups ranging from an all-cause mortality rate of 1.2 per 1,000 person-years for A0 to 15.4 per 1,000 person-years for A3/N4. In multivariable-adjusted models, those with CAC-DRS A3/N4 had significantly higher risk for CHD mortality (HR 5.9 (95% CI 3.6–9.9), CVD mortality (HR4.0 (95% CI 2.8–5.7), and all-cause mortality a (HR 2.5 (95% CI 2.1–3.0) compared to CAC-DRS A0. CAC-DRS had higher AUC than CAC score groups (0.762 vs 0.754, P < 0.001) and CAC distribution (0.762 vs 0.748, P < 0.001). Conclusion: The CAC-DRS system, combining the Agatston score and the number of vessels with CAC provides better stratification of risk for CHD, CVD, and all-cause death than the Agatston score alone. These prognostic data strongly support new SCCT guidelines recommending the use CAC-DRS scoring.

KW - Computed tomography

KW - Coronary artery calcium

KW - Coronary artery calcium data and reporting system

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U2 - 10.1016/j.jcct.2019.03.011

DO - 10.1016/j.jcct.2019.03.011

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JF - Journal of Cardiovascular Computed Tomography

SN - 1934-5925

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