Author + information
- Allison Peng,
- Mohammadhassan Mirbolouk,
- Zeina Dardari,
- Olusola Orimoloye,
- Albert Osei and
- Michael Blaha
Coronary artery calcium (CAC) is commonly used to quantify cardiovascular risk. Current guidelines classify CAC>300 or 400 as the highest risk group, yet little is known about the potentially unique imaging characteristics and mortality risk in individuals with CAC≥1000.
We included 66,636 asymptomatic adults from the CAC Consortium, a large, retrospective, multicenter cohort. Patients were followed-up for mean 12.3 ± 3.9 years for CVD, CHD, cancer, and all-cause mortality. Using multivariable Cox regression models adjusted for age, sex, and traditional risk factors, we assessed the relative mortality hazard of individuals with CAC≥1000 compared first against a reference of CAC=0, and then against CAC 400-999. Cubic splines with knots placed at CAC=100 and CAC=1000 were used to study the dose response relationship between CAC score and mortality outcomes in a multivariable model adjusted for age, sex, and traditional risk factors.
There were 2,869 patients with CAC≥1000 (86.3% male, mean age 66.3 ± 9.7 years). Most CAC≥1000 patients had 4-vessel CAC (mean 3.5 ± 0.6 vessels), and had greater total CAC area, higher mean CAC density, and more extra-coronary calcium (79% with TAC, 46% with AVC, 21% with MVC) compared to CAC 400-999. After full adjustment, those with CAC≥1000 had 5.04 (3.92-6.48), 6.79 (4.74-9.73), 1.55 (1.23-1.95), and 2.89-fold (2.53-3.31) risk of CVD, CHD, cancer, and all-cause mortality, respectively, compared to those with CAC=0. The CAC≥1000 group had a 1.71- (1.41-2.08), 1.84- (1.43-2.36), 1.36- (1.07-1.73), and 1.51-fold (1.33-1.70) increased CVD, CHD, cancer, and all-cause mortality compared to CAC 400-999. Graphical analysis of CAC≥1000 revealed no upper threshold of risk with CAC.
Patients with extensive CAC (CAC≥1000) represent a unique, very high-risk phenotype with CVD mortality outcomes (0.80%/yr) commensurate with high-risk secondary prevention patients (0.77%/yr from the FOURIER trial). Such data on those with CAC≥1000 helps to blur the lines between primary and secondary prevention. Future guidelines should consider CAC≥1000 a distinct risk group that may benefit from the most aggressive preventive therapy.
Poster Hall, Hall F
Sunday, March 17, 2019, 3:45 p.m.-4:30 p.m.
Session Title: Interventional Cardiology: Complex Patients/Comorbidities 4
Abstract Category: 27. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography
Presentation Number: 1250-004
- 2019 American College of Cardiology Foundation