Author + information
- Jamal S. Rana,
- Michael Pencina,
- Michael Blaha,
- Roger Blumenthal,
- Arthur Agatston,
- James K. Min,
- Ron Blankstein,
- Nathan D. Wong,
- Joao Lima,
- Leslee J. Shaw,
- Mathew J. Budoff,
- Mary Cushman,
- Daniel Berman and
- Khurram Nasir
Direct comparison of incremental prognostic value of coronary artery calcium (CAC) score versus multiple well-studied biomarkers, over Framingham Risk Score (FRS), for predicting coronary heart disease (CHD) in a large cohort remains unexplored.
The Multi-Ethnic Study of Atherosclerosis (MESA) is a cohort study of participants without CHD at baseline. Data on CAC and biomarkers (hsCRP, fibrinogen, homocysteine, Interluekin-6, D-dimer, BNP) was available for 5,459 participants (62±10 years, 48% male). Multivariable Cox proportional hazard models were used to estimate hazard ratios per 1-SD increment in log biomarker concentration. C-statistic and net reclassification improvement (NRI) were used to compare incremental contributions of each marker when added to the FRS.
After a median follow-up of 7 years, 268 (4.9%) CHD events were noted. Four out of six biomarkers were associated with risk of all CHD (table); however, addition of individual biomarkers to the FRS did not improve the c-statistic. Although the c-statistic increased significantly (0.728 to 0.750) for the multiple biomarker score, the incremental increase was higher with addition of log CAC (0.728 to 0.795). Similarly, the NRI with CAC (0.28, 95% Cl, 0.20-0.35) was higher compared to the multiple biomarker score (0.08, 95% Cl 0.01-0.15).
CAC provided superior discrimination and risk reclassification compared to individual well-known biomarkers and a multiple biomarkers approach.
Oral Contributions West, Room 3010
Saturday, March 09, 2013, 8:30 a.m.-8:45 a.m.
Session Title: Coronary Calcium and Cardiac CTA: Diagnosis Prognosis, New Insights
Abstract Category: 20. Imaging: CT/Multimodality
Presentation Number: 908-5
- 2013 American College of Cardiology Foundation