0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

Long-Term Prognosis After Coronary Artery Calcification Testing in Asymptomatic Patients: A Cohort StudyLong-Term Prognosis After CAC Testing in Asymptomatic Patients

Leslee J. Shaw, PhD; Ashley E. Giambrone, PhD; Michael J. Blaha, MD; Joseph T. Knapper, MD; Daniel S. Berman, MD; Naveen Bellam, MD; Arshed Quyyumi, MD; Matthew J. Budoff, MD; Tracy Q. Callister, MD; and James K. Min, MD
[+] Article, Author, and Disclosure Information

From Emory University School of Medicine, Atlanta, Georgia; Weill Cornell Medical College, New York, New York; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Cedars-Sinai Medical Center and Harbor–UCLA Medical Center, Los Angeles, California; and Tennessee Heart and Vascular Institute, Hendersonville, Tennessee.

Disclosures: Dr. Blaha reports grants from the U.S. Food and Drug Administration/National Institutes of Health, American Heart Association, and Aetna and personal fees from Pfizer and Luitpold Pharmaceuticals outside the submitted work. Dr. Budoff reports grants from General Electric Healthcare during the conduct of the study. Dr. Min reports grants from the National Heart, Lung, and Blood Institute and National Research Foundation of Korea and other from Michael Wolk Heart Foundation and General Electric Healthcare during the conduct of the study, as well as other from Vital Images, Philips Healthcare, Arineta, AstraZeneca, Bristol-Myers Squibb, and HeartFlow outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/Conflict OfInterestForms.do?msNum=M14-0612.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.

Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Dr. Shaw (e-mail, lshaw3@emory.edu).

Requests for Single Reprints: Leslee J. Shaw, PhD, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road Northeast, Room 529, Atlanta, GA 30322; e-mail, leslee.shaw@emory.edu.

Current Author Addresses: Dr. Shaw: Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road Northeast, Room 529, Atlanta, GA 30322.

Dr. Giambrone: Department of Public Health, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065.

Dr. Blaha: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Carnegie 565A, 600 North Wolfe Street, Baltimore, MD 21287.

Dr. Knapper: Emory University School of Medicine, 116 Ponce de Leon Avenue Northeast, 2314, Atlanta, GA 30308.

Dr. Berman: Cedars-Sinai Medical Center, 8700 Beverly Boulevard, 1258 Taper Building, Los Angeles, CA 90048-0750.

Dr. Bellam: Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19147.

Dr. Quyyumi: Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road Northeast, Suite 507, Atlanta, GA 30322.

Dr. Budoff: Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA 90502.

Dr. Callister: Tennessee Heart and Vascular Institute, 353 New Shackle Island Road, Hendersonville, TN 37075.

Dr. Min: Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065.

Author Contributions: Conception and design: L.J. Shaw, D.S. Berman, A. Quyyumi, M.J. Budoff, T.Q. Callister, J.K. Min.

Analysis and interpretation of the data: L.J. Shaw, A.E. Giambrone, M.J. Blaha, N. Bellam, M.J. Budoff, T.Q. Callister.

Drafting of the article: L.J. Shaw, N. Bellam, J.K. Min.

Critical revision of the article for important intellectual content: L.J. Shaw, M.J. Blaha, J.T. Knapper, D.S. Berman, A. Quyyumi, M.J. Budoff, T.Q. Callister, J.K. Min.

Final approval of the article: L.J. Shaw, M.J. Blaha, J.T. Knapper, D.S. Berman, A. Quyyumi, M.J. Budoff, T.Q. Callister, J.K. Min.

Provision of study materials or patients: T.Q. Callister, J.K. Min.

Statistical expertise: L.J. Shaw, A.E. Giambrone, M.J. Blaha, J.K. Min.

Obtaining of funding: J.K. Min.

Administrative, technical, or logistic support: L.J. Shaw, T.Q. Callister, J.K. Min.

Collection and assembly of data: M.J. Budoff, T.Q. Callister, J.K. Min.


Ann Intern Med. 2015;163(1):14-21. doi:10.7326/M14-0612
Text Size: A A A

Background: The extent of coronary artery calcification (CAC) and near-term adverse clinical outcomes are strongly related through 5 years of follow-up.

Objective: To describe the ability of CAC scores to predict long-term mortality in persons without symptoms of coronary artery disease.

Design: Observational cohort.

Setting: Single-center, outpatient cardiology laboratory.

Patients: 9715 asymptomatic patients.

Measurements: Coronary artery calcification scoring and binary risk factor data were collected. The primary end point was time to all-cause mortality (median follow-up, 14.6 years). Univariable and multivariable Cox proportional hazards models were used to compare survival distributions. The net reclassification improvement statistic was calculated.

Results: In Cox models adjusted for risk factors for coronary artery disease, the CAC score was highly predictive of all-cause mortality (P < 0.001). Overall 15-year mortality rates ranged from 3% to 28% for CAC scores from 0 to 1000 or greater (P < 0.001). The relative hazard for all-cause mortality ranged from 1.68 for a CAC score of 1 to 10 (P < 0.001) to 6.26 for a score of 1000 or greater (P < 0.001). The categorical net reclassification improvement using cut points of less than 7.5% to 22.5% or greater was 0.21 (95% CI, 0.16 to 0.32).

Limitations: Data collection was limited to a single center with generalizability limitations. Only binary risk factor data were available, and CAC was only measured once.

Conclusion: The extent of CAC accurately predicts 15-year mortality in a large cohort of asymptomatic patients. Long-term estimates of mortality provide a unique opportunity to examine the value of novel biomarkers, such as CAC, in estimating important patient outcomes.

Primary Funding Source: None.

Figures

Grahic Jump Location
Figure.

Cumulative incidence of all-cause mortality by CAC across 15-y predicted mortality quartiles.

All P values are <0.001. CAC = coronary artery calcification.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment/Letter
Coronary artery calcium screening can prevent heart attack irrespective of cardiometabolic risk factors.
Posted on July 9, 2015
Gauranga Dhar
Bangladesh institute of Family Medicine and Research
Conflict of Interest: None Declared
Coronary atherosclerosis is the major cause of coronary artery diseases and heart attack. It is vital for a physician to detect atherosclerotic burden of a patient even at subclinical atherosclerotic state. This study should have a good practical implication that by detecting severity of coronary artery calcium (CAC) score a physician can predict prognosis of vascular health including heart attack and take necessary action in advance.
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Topic Collections
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)