A comparison of outcomes with coronary artery calcium scanning in unselected populations: The Multi-Ethnic Study of Atherosclerosis (MESA) and Heinz Nixdorf RECALL study (HNR) |
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| Authors: | Matthew J Budoff Stefan Möhlenkamp Robyn McClelland Joseph A Delaney Marcus Bauer Heinz Karl Jöckel Hagen Kälsch Richard Kronmal Khurram Nasir Nils Lehmann Susanne Moebus Ken Mukamal Raimund Erbel |
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| Institution: | 1. Los Angeles Biomedical Research Center, 1124 W Carson St, Torrance, CA 90502, USA;2. Department of Cardiology, University of Duisburg-Essen, Essen, Germany;3. Department of Biostatistics, University of Washington, Seattle, WA, USA;4. College of Pharmacy, University of Florida, Gainesville, FL, USA;5. Institut of Medical Informatics, Biometry, and Epidemiology, University of Duisburg-Essen, Essen, Germany;6. Department of Radiology and CardioVascular Center, Tufts Medical Center, Boston, MA, USA;7. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA;1. Department of Medicine, Cardiology Division, Medstar Georgetown University Hospital, 3800 Reservoir Road NW, 5PHC, Washington, DC 20007, USA;2. Siemens Healthcare, Forscheim, Germany;3. Austin Health, Melbourne, Australia;4. Department of Medicine, New York University School of Medicine, 660 First Ave, 2nd Floor, New York, NY 10016, USA;5. Department of Radiology, New York University School of Medicine, New York, NY, USA;1. Radiological Institute, Friedrich-Alexander-University-Erlangen-Nuremberg, Maximiliansplatz 1, 91054 Erlangen, Germany;2. Division of Cardiology, Department of Internal Medicine II, Friedrich-Alexander-University-Erlangen-Nuremberg, Erlangen, Germany;1. Monash Cardiovascular Research Center, MonashHEART, Monash Medical Center, 246 Clayton Road, Clayton 3168, Australia;2. Monash University Department of Medicine (MMC), Melbourne, Australia;3. Diagnostic Imaging, Southern Health, Melbourne, Australia;2. Laboratorio de Física Médica, Instituto Nacional de Neurología y Neurocirugía, Mexico;1. St Vincent’s Hospital, Sydney, Australia;2. University of New South Wales, Australia;3. King’s College London, Division of Imaging Sciences, The Rayne Institute, 4th Floor Lambeth Wing, St. Thomas’ Hospital, London SE1 7EH, United Kingdom;4. Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark;1. Divisions of Cardiology and Cardiac Imaging, St. Paul''s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada;2. Divisions of Cardiology and Cardiac Imaging Center, Aarhus University Hospital Skejby, Aarhus, Denmark;3. Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA;4. Québec Heart and Lung Institute, Laval University, Québec, QC, Canada |
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| Abstract: | BackgroundThe Multi-Ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf RECALL (Risk factors, Evaluation of Coronary Calcium and Lifestyle Factors) study (HNR) differed in regard to informing physicians and patients of the results of their subclinical atherosclerosis.ObjectiveThis study investigates whether the association of the presence of coronary calcium with incident nonfatal and fatal cardiovascular events is different among these 2 large, population-based observational studies.MethodsAll white subjects aged 45 to 75 years, free of baseline cardiovascular disease were included (n = 2232 in MESA; n = 3119 HNR participants). We studied the association between coronary calcium and event rates at 5 years, including hard cardiac events (myocardial infarction, cardiac death, resuscitated cardiac arrest), and separately added revascularizations and strokes (fatal and nonfatal) to determine adjusted hazard ratios.ResultsBoth cohorts showed low coronary heart disease (including revascularization) rates with zero coronary calcium (1.13% and 1.16% over 5 years in MESA and HNR, respectively) and increasing significantly in both groups with Agatston score 100 to 399 (6.71% and 4.52% in MESA and HNR, respectively) and Agatston score > 400 (12.5% and 13.54% in MESA and HNR, respectively) and showing strong independent predictive values for Agatston scores of 100 to 399 and >400, despite multivariable adjustment for risk factors. Risk factor-adjusted 5-year revascularization rates were nearly identical for HNR and MESA and were generally low for both studies (1.4% 45 of 3119] for HNR and 1.9% 43 of 2232] for MESA) over 5 years.ConclusionsAcross 2 culturally diverse populations, Agatston score >400 is a strong predictor of events. High Agatston score did not statistically result in revascularization, and knowledge of the presence of coronary calcium did not increase revascularizations. |
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| Keywords: | Coronary artery calcification Subclinical atherosclerosis Multi-Ethnic Study of Atherosclerosis Heinz Nixdorf RECALL study |
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