TY  - JOUR
A1  - Lehmann, Nils
A1  - Erbel, Raimund
A1  - Mahabadi, Amir Abbas
A1  - Rauwolf, Michael
A1  - Möhlenkamp, Stefan
A1  - Moebus, Susanne
A1  - Kälsch, Hagen
A1  - Budde, Thomas
A1  - Schmermund, Axel
A1  - Stang, Andreas
A1  - Führer-Sakel, Dagmar
A1  - Weimar, Christian
A1  - Roggenbuck, Ulla
A1  - Dragano, Nico
A1  - Jöckel, Karl-Heinz
T1  - Value of progression of coronary artery calcification for risk prediction of coronary and cardiovascular events
T2  - Circulation
N2  - Background: Computed tomography (CT) allows estimation of coronary artery calcium (CAC) progression. We evaluated several progression algorithms in our unselected, population-based cohort for risk prediction of coronary and cardiovascular events.
Methods: In 3281 participants (45–74 years of age), free from cardiovascular disease until the second visit, risk factors, and CTs at baseline (b) and after a mean of 5.1 years (5y) were measured. Hard coronary and cardiovascular events, and total cardiovascular events including revascularization, as well, were recorded during a follow-up time of 7.8±2.2 years after the second CT. The added predictive value of 10 CAC progression algorithms on top of risk factors including baseline CAC was evaluated by using survival analysis, C-statistics, net reclassification improvement, and integrated discrimination index. A subgroup analysis of risk in CAC categories was performed.
Results: We observed 85 (2.6%) hard coronary, 161 (4.9%) hard cardiovascular, and 241 (7.3%) total cardiovascular events. Absolute CAC progression was higher with versus without subsequent coronary events (median, 115 [Q1–Q3, 23–360] versus 8 [0–83], P<0.0001; similar for hard/total cardiovascular events). Some progression algorithms added to the predictive value of baseline CT and risk assessment in terms of C-statistic or integrated discrimination index, especially for total cardiovascular events. However, CAC progression did not improve models including CAC5y and 5-year risk factors. An excellent prognosis was found for 921 participants with double-zero CACb=CAC5y=0 (10-year coronary and hard/total cardiovascular risk: 1.4%, 2.0%, and 2.8%), which was for participants with incident CAC 1.8%, 3.8%, and 6.6%, respectively. When CACb progressed from 1 to 399 to CAC5y≥400, coronary and total cardiovascular risk were nearly 2-fold in comparison with subjects who remained below CAC5y=400. Participants with CACb≥400 had high rates of hard coronary and hard/total cardiovascular events (10-year risk: 12.0%, 13.5%, and 30.9%, respectively).
Conclusions: CAC progression is associated with coronary and cardiovascular event rates, but adds only weakly to risk prediction. What counts is the most recent CAC value and risk factor assessment. Therefore, a repeat scan >5 years after the first scan may be of additional value, except when a double-zero CT scan is present or when the subjects are already at high risk.
KW  - atherosclerosis
KW  - coronary disease
KW  - disease progression
KW  - risk assessment
KW  - tomography
KW  - vascular calcification
Y1  - 2018
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/50065
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-500659
SN  - 1941-3149
SN  - 1941-3084
N1  - © 2017 The Authors.
Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.
VL  - 137
IS  - 7
SP  - 665
EP  - 679
PB  - Lippincott, Williams & Wilkins
CY  - Philadelphia, Pa.
ER  -