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.
Adult
Aged
Cause of Death
Coronary Angiography
Coronary Artery Disease
/ diagnostic imaging
Databases, Factual
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Prognosis
Radiology Information Systems
Reproducibility of Results
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
United States
Vascular Calcification
/ diagnostic imaging
Computed tomography
Coronary artery calcium
Coronary artery calcium data and reporting system
Journal
Journal of cardiovascular computed tomography
ISSN: 1876-861X
Titre abrégé: J Cardiovasc Comput Tomogr
Pays: United States
ID NLM: 101308347
Informations de publication
Date de publication:
Historique:
received:
31
01
2019
revised:
12
03
2019
accepted:
25
03
2019
pubmed:
7
4
2019
medline:
7
7
2020
entrez:
7
4
2019
Statut:
ppublish
Résumé
The 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. We 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. The 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). The 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.
Sections du résumé
BACKGROUND
BACKGROUND
The 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.
METHODS
METHODS
We 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.
RESULTS
RESULTS
The 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).
CONCLUSION
CONCLUSIONS
The 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.
Identifiants
pubmed: 30952612
pii: S1934-5925(19)30062-0
doi: 10.1016/j.jcct.2019.03.011
pmc: PMC6765460
mid: NIHMS1526186
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
12-17Subventions
Organisme : NHLBI NIH HHS
ID : L30 HL110027
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
Références
Atherosclerosis. 2015 Jan;238(1):126-31
pubmed: 25479801
AJR Am J Roentgenol. 2005 Dec;185(6):1542-5
pubmed: 16304010
Radiology. 2015 Jul;276(1):82-90
pubmed: 25759972
JACC Cardiovasc Imaging. 2016 Dec;9(12):1407-1416
pubmed: 27085449
Atherosclerosis. 2014 Nov;237(1):1-4
pubmed: 25173946
JACC Cardiovasc Imaging. 2017 Aug;10(8):923-937
pubmed: 28797416
JACC Cardiovasc Imaging. 2014 May;7(5):476-486
pubmed: 24831208
J Am Coll Cardiol. 1990 Mar 15;15(4):827-32
pubmed: 2407762
Eur Heart J. 2018 Nov 1;39(41):3727-3735
pubmed: 30212857
J Cardiovasc Comput Tomogr. 2018 May - Jun;12(3):185-191
pubmed: 29793848
JAMA. 2014 Apr 9;311(14):1406-15
pubmed: 24682252
Eur Heart J. 2012 May;33(10):1201-13
pubmed: 22547221
Am J Cardiol. 2009 Jan 1;103(1):59-63
pubmed: 19101230
J Cardiovasc Comput Tomogr. 2017 Mar - Apr;11(2):157-168
pubmed: 28283309
J Am Coll Cardiol. 2018 Jul 24;72(4):434-447
pubmed: 30025580
J Cardiovasc Comput Tomogr. 2017 Jan - Feb;11(1):54-61
pubmed: 27884729
J Thorac Imaging. 2017 Sep;32(5):W54-W66
pubmed: 28832417
Am J Cardiol. 2015 May 1;115(9):1229-34
pubmed: 25743208
J Am Heart Assoc. 2018 Oct 16;7(20):e010471
pubmed: 30371271
J Am Coll Cardiol. 2019 Jun 25;73(24):3168-3209
pubmed: 30423391
Clin Cardiol. 2014 Aug;37(8):456-61
pubmed: 25138770