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J Am Coll Cardiol, 2007; 49:1860-1870, doi:10.1016/j.jacc.2006.10.079 (Published online 19 April 2007).
© 2007 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: CARDIAC IMAGING

Long-Term Prognosis Associated With Coronary Calcification

Observations From a Registry of 25,253 Patients

Matthew J. Budoff, MD*,*,1, Leslee J. Shaw, PhD{dagger}, Sandy T. Liu*, Steven R. Weinstein*, Tristen P. Mosler, Philip H. Tseng*, Ferdinand R. Flores*, Tracy Q. Callister, MD{ddagger}, Paolo Raggi, MD§ and Daniel S. Berman, MD{dagger}

* Harbor-UCLA Los Angeles Biomedical Research Institute, Torrance, California
{dagger} Cedars-Sinai Medical Center, Los Angeles, California
{ddagger} EBT Research Foundation, Nashville, Tennessee
§ Division of Cardiology and Department of Radiology, Emory University, Atlanta, Georgia.

Manuscript received March 6, 2006; revised manuscript received September 18, 2006, accepted October 16, 2006.

* Reprint requests and correspondence: Dr. Matthew J. Budoff, Harbor-UCLA Research and Education Institute, 1124 West Carson Street, RB2, Torrance, California 90502. (Email: mbudoff{at}labiomed.org).

Objectives: The purpose of this study was to develop risk-adjusted multivariable models that include risk factors and coronary artery calcium (CAC) scores measured with electron-beam tomography in asymptomatic patients for the prediction of all-cause mortality.

Background: Several smaller studies have documented the efficacy of CAC testing for assessment of cardiovascular risk. Larger studies with longer follow-up will lend strength to the hypothesis that CAC testing will improve outcomes, cost-effectiveness, and safety of primary prevention efforts.

Methods: We used an observational outcome study of a cohort of 25,253 consecutive, asymptomatic individuals referred by their primary physician for CAC scanning to assess cardiovascular risk. Multivariable Cox proportional hazards models were developed to predict all-cause mortality. Risk-adjusted models incorporated traditional risk factors for coronary disease and CAC scores.

Results: The frequency of CAC scores was 44%, 14%, 20%, 13%, 6%, and 4% for scores of 0, 1 to 10, 11 to 100, 101 to 400, 401 to 1,000, and >1,000, respectively. During a mean follow-up of 6.8 ± 3 years, the death rate was 2% (510 deaths). The CAC was an independent predictor of mortality in a multivariable model controlling for age, gender, ethnicity, and cardiac risk factors (model chi-square = 2,017, p < 0.0001). The addition of CAC to traditional risk factors increased the concordance index significantly (0.61 for risk factors vs. 0.81 for the CAC score, p < 0.0001). Risk-adjusted relative risk ratios for CAC were 2.2-, 4.5-, 6.4-, 9.2-, 10.4-, and 12.5-fold for scores of 11 to 100, 101 to 299, 300 to 399, 400 to 699, 700 to 999, and >1,000, respectively (p < 0.0001), when compared with a score of 0. Ten-year survival (after adjustment for risk factors, including age) was 99.4% for a CAC score of 0 and worsened to 87.8% for a score of >1,000 (p < 0.0001).

Conclusions: This large observational data series shows that CAC provides independent incremental information in addition to traditional risk factors in the prediction of all-cause mortality.

Abbreviations and Acronyms
  CAC = coronary artery calcium
  CAD = coronary artery disease
  CHD = coronary heart disease
  CI = confidence interval
  EBT = electron beam tomography
  ROC = receiver-operating characteristic
  RR = risk ratio


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J. Am. Coll. Cardiol. 2007 49: 1871-1873. [Full Text] [PDF]



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