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 |
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| Affiliation: | 1. Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, United States;2. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States;3. Department of Radiology and Neuroradiology, Charité, Berlin, Germany;4. Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD, United States;5. Department of Nuclear Cardiology/Cardiac Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States;6. Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, United States;7. Department of Radiology and Medicine, Weill Cornell Medical College, New York, NY, United States;8. Department of Medicine, St. Luke''s Roosevelt Hospital Center, New York, NY, United States;9. Department of Medicine, Yale School of Medicine, New Haven, CT, United States;10. Center for Outcomes Research & Evaluation, Yale School of Medicine, New Haven, CT, United States;11. Department of Cardiovascular Imaging, Princeton Longevity Center, Princeton, NJ, United States;12. Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, United States;13. Cardiovascular Imaging and PET, Houston Methodist DeBakey Heart & Vascular Center, Houston Texas, Texas, United States;14. Cardiovascular Imaging Program, Brigham and Women''s Hospital and Harvard Medical School, United States;1. The Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA;2. University of Miami Miller School of Medicine, Miami, FL, USA;3. Aetna Foundation, Hartford, CT, USA;4. Princeton Longevity Center, Princeton, NJ, USA;5. Department of Radiology and Medicine, Weill Cornell Medical College, New York, NY, USA;6. Cardiology, Los Angeles Biomedical Research Center, Torrance, CA, USA;7. Department of Medicine, St. Luke''s Roosevelt Hospital Center, New York, NY, USA;8. Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA;9. Houston Methodist Heart and Vascular Center, Houston, TX, USA;10. Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA;11. Cardiology & Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, New Haven, CT, USA;1. Saint Francis Hospital, Roslyn, NY, USA;2. University of Kansas Medical Center, Kansas City, KS, USA;3. St. John''s University, Queens, New York, USA;4. State University of New York at Stony Brook, New York, USA |
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| Abstract: | BackgroundThe 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.MethodsWe 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.ResultsThe 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).ConclusionThe 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. |
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| Keywords: | Coronary artery calcium data and reporting system Coronary artery calcium Computed tomography |
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