TY - JOUR
T1 - Warranty Period of a Calcium Score of Zero
T2 - Comprehensive Analysis From MESA
AU - Dzaye, Omar
AU - Dardari, Zeina A.
AU - Cainzos-Achirica, Miguel
AU - Blankstein, Ron
AU - Agatston, Arthur S.
AU - Duebgen, Matthias
AU - Yeboah, Joseph
AU - Szklo, Moyses
AU - Budoff, Matthew J.
AU - Lima, Joao A.C.
AU - Blumenthal, Roger S.
AU - Nasir, Khurram
AU - Blaha, Michael J.
N1 - Publisher Copyright:
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2021/5/1
Y1 - 2021/5/1
N2 - OBJECTIVES: This study sought to quantify and model conversion of a normal coronary artery calcium (CAC) scan to an abnormal CAC scan. BACKGROUND: Although the absence of CAC is associated with excellent prognosis, progression to CAC >0 confers increased risk. The time interval for repeated scanning remains poorly defined. METHODS: This study included 3,116 participants from the MESA (Multi-Ethnic Study of Atherosclerosis) with baseline CAC = 0 and follow-up scans over 10 years after baseline. Prevalence of incident CAC, defined by thresholds of CAC >0, CAC >10, or CAC >100, was calculated and time to progression was derived from a Weibull parametric survival model. Warranty periods were modeled as a function of sex, race/ethnicity, cardiovascular risk, and desired yield of repeated CAC testing. Further analysis was performed of the proportion of coronary events occurring in participants with baseline CAC = 0 that preceded and followed repeated CAC testing at different time intervals. RESULTS: Mean participants' age was 58 ± 9 years, with 63% women, and mean 10-year cardiovascular risk of 14%. Prevalence of CAC >0, CAC >10, and CAC >100 was 53%, 36%, and 8%, respectively, at 10 years. Using a 25% testing yield (number needed to scan [NNS] = 4), the estimated warranty period of CAC >0 varied from 3 to 7 years depending on sex and race/ethnicity. Approximately 15% of participants progressed to CAC >10 in 5 to 8 years, whereas 10-year progression to CAC >100 was rare. Presence of diabetes was associated with significantly shorter warranty period, whereas family history and smoking had small effects. A total of 19% of all 10-year coronary events occurred in CAC = 0 prior to performance of a subsequent scan at 3 to 5 years, whereas detection of new CAC >0 preceded 55% of future events and identified individuals at 3-fold higher risk of coronary events. CONCLUSIONS: In a large population of individuals with baseline CAC = 0, study data provide a robust estimation of the CAC = 0 warranty period, considering progression to CAC >0, CAC >10, and CAC >100 and its impact on missed versus detectable 10-year coronary heart disease events. Beyond age, sex, race/ethnicity, diabetes also has a significant impact on the warranty period. The study suggests that evidence-based guidance would be to consider rescanning in 3 to 7 years depending on individual demographics and risk profile.
AB - OBJECTIVES: This study sought to quantify and model conversion of a normal coronary artery calcium (CAC) scan to an abnormal CAC scan. BACKGROUND: Although the absence of CAC is associated with excellent prognosis, progression to CAC >0 confers increased risk. The time interval for repeated scanning remains poorly defined. METHODS: This study included 3,116 participants from the MESA (Multi-Ethnic Study of Atherosclerosis) with baseline CAC = 0 and follow-up scans over 10 years after baseline. Prevalence of incident CAC, defined by thresholds of CAC >0, CAC >10, or CAC >100, was calculated and time to progression was derived from a Weibull parametric survival model. Warranty periods were modeled as a function of sex, race/ethnicity, cardiovascular risk, and desired yield of repeated CAC testing. Further analysis was performed of the proportion of coronary events occurring in participants with baseline CAC = 0 that preceded and followed repeated CAC testing at different time intervals. RESULTS: Mean participants' age was 58 ± 9 years, with 63% women, and mean 10-year cardiovascular risk of 14%. Prevalence of CAC >0, CAC >10, and CAC >100 was 53%, 36%, and 8%, respectively, at 10 years. Using a 25% testing yield (number needed to scan [NNS] = 4), the estimated warranty period of CAC >0 varied from 3 to 7 years depending on sex and race/ethnicity. Approximately 15% of participants progressed to CAC >10 in 5 to 8 years, whereas 10-year progression to CAC >100 was rare. Presence of diabetes was associated with significantly shorter warranty period, whereas family history and smoking had small effects. A total of 19% of all 10-year coronary events occurred in CAC = 0 prior to performance of a subsequent scan at 3 to 5 years, whereas detection of new CAC >0 preceded 55% of future events and identified individuals at 3-fold higher risk of coronary events. CONCLUSIONS: In a large population of individuals with baseline CAC = 0, study data provide a robust estimation of the CAC = 0 warranty period, considering progression to CAC >0, CAC >10, and CAC >100 and its impact on missed versus detectable 10-year coronary heart disease events. Beyond age, sex, race/ethnicity, diabetes also has a significant impact on the warranty period. The study suggests that evidence-based guidance would be to consider rescanning in 3 to 7 years depending on individual demographics and risk profile.
KW - coronary artery calcium
KW - coronary artery disease
KW - risk assessment
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UR - http://www.scopus.com/inward/citedby.url?scp=85104607840&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2020.06.048
DO - 10.1016/j.jcmg.2020.06.048
M3 - Article
C2 - 33129734
AN - SCOPUS:85097063157
SN - 1936-878X
VL - 14
SP - 990
EP - 1002
JO - JACC. Cardiovascular imaging
JF - JACC. Cardiovascular imaging
IS - 5
ER -