TY - JOUR
T1 - Coronary Artery Calcium for Risk Stratification of Sudden Cardiac Death
T2 - The Coronary Artery Calcium Consortium
AU - Razavi, Alexander C.
AU - Uddin, S. M.Iftekhar
AU - Dardari, Zeina A.
AU - Berman, Daniel S.
AU - Budoff, Matthew J.
AU - Miedema, Michael D.
AU - Osei, Albert D.
AU - Obisesan, Olufunmilayo H.
AU - Nasir, Khurram
AU - Rozanski, Alan
AU - Rumberger, John A.
AU - Shaw, Leslee J.
AU - Sperling, Laurence S.
AU - Whelton, Seamus P.
AU - Mortensen, Martin Bødtker
AU - Blaha, Michael J.
AU - Dzaye, Omar
N1 - Funding Information:
This project was supported in part by a research grant from the National Institutes of Health, National Heart, Lung, and Blood Institute (L30 HL110027). Dr Blaha has received grants from the National Institutes of Health, U.S. Food and Drug Administration, American Heart Association, and Aetna Foundation; has received grants and personal fees from Amgen; and has received personal fees from Sanofi, Regeneron, Novartis, Bayer, and Novo Nordisk outside the submitted work. Dr. Dzaye has received support from National Institutes of Health grant T32 HL007227. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/7
Y1 - 2022/7
N2 - Background: Coronary artery calcium (CAC) is a marker of plaque burden. Whether CAC improves risk stratification for incident sudden cardiac death (SCD) beyond atherosclerotic cardiovascular disease (ASCVD) risk factors is unknown. Objectives: SCD is a common initial manifestation of coronary heart disease (CHD); however, SCD risk prediction remains elusive. Methods: The authors studied 66,636 primary prevention patients from the CAC Consortium. Multivariable competing risks regression and C-statistics were used to assess the association between CAC and SCD, adjusting for demographics and traditional risk factors. Results: The mean age was 54.4 years, 33% were women, 11% were of non-White ethnicity, and 55% had CAC >0. A total of 211 SCD events (0.3%) were observed during a median follow-up of 10.6 years, 91% occurring among those with baseline CAC >0. Compared with CAC = 0, there was a stepwise higher risk (P trend < 0.001) in SCD for CAC 100 to 399 (subdistribution hazard ratio [SHR]: 2.8; 95% CI: 1.6-5.0), CAC 400 to 999 (SHR: 4.0; 95% CI: 2.2-7.3), and CAC >1,000 (SHR: 4.9; 95% CI: 2.6-9.9). CAC provided incremental improvements in the C-statistic for the prediction of SCD among individuals with a 10-year risk <7.5% (ΔC-statistic = +0.046; P = 0.02) and 7.5% to 20% (ΔC-statistic = +0.069; P = 0.003), which were larger when compared with persons with a 10-year risk >20% (ΔC-statistic = +0.01; P = 0.54). Conclusions: Higher CAC burden strongly associates with incident SCD beyond traditional risk factors, particularly among primary prevention patients with low-intermediate risk. SCD risk stratification can be useful in the early stages of CHD through the measurement of CAC, identifying patients most likely to benefit from further downstream testing.
AB - Background: Coronary artery calcium (CAC) is a marker of plaque burden. Whether CAC improves risk stratification for incident sudden cardiac death (SCD) beyond atherosclerotic cardiovascular disease (ASCVD) risk factors is unknown. Objectives: SCD is a common initial manifestation of coronary heart disease (CHD); however, SCD risk prediction remains elusive. Methods: The authors studied 66,636 primary prevention patients from the CAC Consortium. Multivariable competing risks regression and C-statistics were used to assess the association between CAC and SCD, adjusting for demographics and traditional risk factors. Results: The mean age was 54.4 years, 33% were women, 11% were of non-White ethnicity, and 55% had CAC >0. A total of 211 SCD events (0.3%) were observed during a median follow-up of 10.6 years, 91% occurring among those with baseline CAC >0. Compared with CAC = 0, there was a stepwise higher risk (P trend < 0.001) in SCD for CAC 100 to 399 (subdistribution hazard ratio [SHR]: 2.8; 95% CI: 1.6-5.0), CAC 400 to 999 (SHR: 4.0; 95% CI: 2.2-7.3), and CAC >1,000 (SHR: 4.9; 95% CI: 2.6-9.9). CAC provided incremental improvements in the C-statistic for the prediction of SCD among individuals with a 10-year risk <7.5% (ΔC-statistic = +0.046; P = 0.02) and 7.5% to 20% (ΔC-statistic = +0.069; P = 0.003), which were larger when compared with persons with a 10-year risk >20% (ΔC-statistic = +0.01; P = 0.54). Conclusions: Higher CAC burden strongly associates with incident SCD beyond traditional risk factors, particularly among primary prevention patients with low-intermediate risk. SCD risk stratification can be useful in the early stages of CHD through the measurement of CAC, identifying patients most likely to benefit from further downstream testing.
KW - cardiovascular diseases
KW - coronary artery calcium
KW - multidetector computed tomography
KW - sudden cardiac death
KW - Predictive Value of Tests
KW - Calcium
KW - Risk Assessment
KW - Humans
KW - Middle Aged
KW - Risk Factors
KW - Death, Sudden, Cardiac/epidemiology
KW - Male
KW - Coronary Artery Disease/complications
KW - Female
KW - Vascular Calcification
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U2 - 10.1016/j.jcmg.2022.02.011
DO - 10.1016/j.jcmg.2022.02.011
M3 - Article
C2 - 35370113
AN - SCOPUS:85127311114
SN - 1936-878X
VL - 15
SP - 1259
EP - 1270
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 7
ER -