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ACC/AHA 2008 Performance Measures for Adults With ST-Elevation and Non–ST-Elevation Myocardial Infarction

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease
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J Am Coll Cardiol, 2007; 50:953-960, doi:10.1016/j.jacc.2007.03.066 (Published online 20 August 2007).
© 2007 by the American College of Cardiology Foundation
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Ethnic Differences in the Prognostic Value of Coronary Artery Calcification for All-Cause Mortality

Khurram Nasir, MD, MPH*,1, Leslee J. Shaw, PhD{dagger}, Sandy T. Liu, MD{ddagger}, Steven R. Weinstein, MD{ddagger}, Tristen R. Mosler, MD{ddagger}, Phillip R. Flores, MD{ddagger}, Ferdinand R. Flores, MD{ddagger}, Paolo Raggi, MD{dagger}, Daniel S. Berman, MD§, Roger S. Blumenthal, MD|| and Matthew J. Budoff, MD{ddagger},2,*

* Cardiac MRI PET CT Program, Massachusetts General Hospital Boston, Harvard School of Medicine, Boston, Massachusetts
{dagger} Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia
{ddagger} Division of Cardiology, Harbor-UCLA Medical Center Research and Education Institute, Torrance, California
§ Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California
|| Ciccarone Preventive Cardiology Center, Johns Hopkins University, School of Medicine, Baltimore, Maryland.


Figure 1
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  		Figure 1 Observed Frequency of CAC Score Subsets by Ethnicity (n = 14,812)

Prevalence of any coronary artery calcium (CAC) is 66%, 58%, 55%, and 55% for non-Hispanic whites, African Americans, Hispanics, and Asians, respectively (p < 0.0001). As compared with non-Hispanic white, all ethnic groups had lower odds of having any as well as an increasing burden of CAC (p < 0.0001).

 

Figure 2
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  		Figure 2 Long-Term Survival in Ethnic Subsets (n = 14,812)

Overall survival was 96%, 93%, and 92% for Asians, non-Hispanic whites, and Hispanics as compared with 83% for African Americans, respectively (p < 0.0001). Among all ethnic groups, the lowest survival was observed in African Americans (83%, p < 0.0001).

 

Figure 3
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  		Figure 3 Cumulative Survival By CACS in Ethnic Subsets

(A to D) Using risk-stratified Cox proportional hazard survival analyses, the survival ranged from 98% to 57% in non-Hispanic whites, 97% to 30% in African Americans, 99% to 60% in Hispanics, and 100% to 80% in Asians for coronary artery calcium scores (CACS) of 0 to 10 to ≥1,000.

 

Figure 4
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  		Figure 4 RRRs (95% CIs) for CACS Subsets in HS, AA, and AS Patients as Compared With NHW

The figure depicts the relative risk ratios (RRRs) of events for ethnic subsets with increasing coronary artery calcium scores (CACS) as compared with non-Hispanic whites (NHW). As compared with NHW, the relative risk ratio for CAC ≥1,000 is 9.0 for Hispanics (HS) (n = 1,334), 6.6 for Asians (AS) (n = 1,065), and 24 for African Americans (AA) (n = 637). CI = confidence interval.

 

Figure 5
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  		Figure 5 Predicted Changes in Life Expectancy for Ethnic Subsets by CAC Scores ≥100, ≥400, and ≥1,000, Respectively

The figure depicts the change in life expectancy for ethnic subsets of this registry for those with significant-to-extensive atherosclerosis including those with coronary artery calcium (CAC) scores ≥100, ≥400, and ≥1,000, respectively. The life expectancy (on the vertical axis) is plotted by age of individual (horizontal axis). The decline in life expectancy was highest among ethnic minorities with increasing levels of CAC burden.

 


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