Author + information
- Received February 17, 2010
- Revision received June 9, 2010
- Accepted June 15, 2010
- Published online October 19, 2010.
- Raimund Erbel, MD⁎,⁎ (, )
- Stefan Möhlenkamp, MD⁎,
- Susanne Moebus, PhD†,
- Axel Schmermund, MD‡,
- Nils Lehmann, PhD†,
- Andreas Stang, MD§,
- Nico Dragano, PhD∥,
- Dietrich Grönemeyer, MD¶,
- Rainer Seibel, MD#,
- Hagen Kälsch, MD⁎,
- Martina Bröcker-Preuss, PhD⁎⁎,
- Klaus Mann, MD⁎⁎,
- Johannes Siegrist, MD∥,
- Karl-Heinz Jöckel, PhD†,
- Heinz Nixdorf Recall Study Investigative Group
- ↵⁎Reprint requests and correspondence:
Dr. Raimund Erbel, Department of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Hufelandstrasse 55, D-45122 Essen, Germany
Objectives The purpose of this study was to determine net reclassification improvement (NRI) and improved risk prediction based on coronary artery calcification (CAC) scoring in comparison with traditional risk factors.
Background CAC as a sign of subclinical coronary atherosclerosis can noninvasively be detected by CT and has been suggested to predict coronary events.
Methods In 4,129 subjects from the HNR (Heinz Nixdorf Recall) study (age 45 to 75 years, 53% female) without overt coronary artery disease at baseline, traditional risk factors and CAC scores were measured. Their risk was categorized into low, intermediate, and high according to the Framingham Risk Score (FRS) and National Cholesterol Education Panel Adult Treatment Panel (ATP) III guidelines, and the reclassification rate based on CAC results was calculated.
Results After 5 years of follow-up, 93 coronary deaths and nonfatal myocardial infarctions occurred (cumulative risk 2.3%; 95% confidence interval: 1.8% to 2.8%). Reclassifying intermediate (defined as 10% to 20% and 6% to 20%) risk subjects with CAC <100 to the low-risk category and with CAC ≥400 to the high-risk category yielded an NRI of 21.7% (p = 0.0002) and 30.6% (p < 0.0001) for the FRS, respectively. Integrated discrimination improvement using FRS variables and CAC was 1.52% (p < 0.0001). Adding CAC scores to the FRS and National Cholesterol Education Panel ATP III categories improved the area under the curve from 0.681 to 0.749 (p < 0.003) and from 0.653 to 0.755 (p = 0.0001), respectively.
Conclusions CAC scoring results in a high reclassification rate in the intermediate-risk cohort, demonstrating the benefit of imaging of subclinical coronary atherosclerosis. Our study supports its application, especially in carefully selected individuals with intermediate risk.
- cardiac death
- coronary artery calcification
- myocardial infarction
- risk factors
- subclinical atherosclerosis
This study is supported by the German Ministry of Education and Science (BMBF), and the German AeroCenter (Deutsches Zentrum für Luft- und Raumfahrt [DLR]), Bonn, Germany. Assessment of psychosocial factors and neighborhood level information is funded by the German Research Council(DFG; Project SI 236/8-1and SI 236/9-1). The authors acknowledge the support of the Sarstedt AG & Co.(Nümbrecht, Germany) concerning laboratory equipment. The authors have reported that they have no relationships to disclose.
Presented in part at the Late Breaking Clinical Trial, 58th Annual Scientific Session of the American College of Cardiology, 2009, and American Heart Association Scientific Sessions 2009.
- Received February 17, 2010.
- Revision received June 9, 2010.
- Accepted June 15, 2010.
- American College of Cardiology Foundation