TY - JOUR
T1 - Coronary Artery Calcium Dispersion and Cause-Specific Mortality
AU - Dudum, Ramzi
AU - Dardari, Zeina A.
AU - Feldman, David I.
AU - Berman, Daniel S.
AU - Budoff, Matthew J.
AU - Miedema, Michael D.
AU - Nasir, Khurram
AU - Rozanski, Alan
AU - Rumberger, John A.
AU - Shaw, Leslee
AU - Dzaye, Omar
AU - Caínzos-Achirica, Miguel
AU - Patel, Jaideep
AU - Blaha, Michael J.
N1 - Funding Information:
This study was funded by Grant L30 HL110027 from National Institutes of Health/National Heart, Lung, and Blood Institute, Bethesda, Maryland.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2023/3/15
Y1 - 2023/3/15
N2 - Coronary artery calcium (CAC) measures subclinical atherosclerosis and improves risk stratification. CAC characteristics—including vessel(s) involved, number of vessels, volume, and density—have been shown to differentially impact risk. We assessed how dispersion—either the number of calcified vessels or CAC phenotype (diffuse, normal, and concentrated)—impacted cause-specific mortality. The CAC Consortium is a retrospective cohort of 66,636 participants without coronary heart disease (CHD) who underwent CAC scoring. This study included patients with CAC >0 (n = 28,147). CAC area, CAC density, and CAC phenotypes (derived from the index of diffusion = 1 – [CAC in most concentrated vessel/total Agatston score]) were calculated. The associations between CAC characteristics and cause-specific mortality were assessed. The participant details included (n = 28,147): mean age 58.3 years, 25% female, 89.6% White, and 66% had 2+ calcified vessels. Diabetes, hypertension, and hyperlipidemia were predictors of multivessel involvement (p <0.001). After controlling for the overall CAC score, those with 4-vessel CAC involvement had more CAC area and less dense calcifications than those with 1-vessel. There was a graded increase in all-cause and cardiovascular disease (CVD)- and CHD-specific mortality as the number of calcified vessels increased. Among those with ≥2 vessels involved (n = 18,516), a diffuse phenotype was associated with a higher CVD-specific mortality and had a trend toward higher all-cause and CHD-specific mortality than a concentrated CAC phenotype. Diffuse CAC involvement was characterized by less dense calcification, more CAC area, multiple coronary vessel involvement, and presence of certain traditional risk factors. There is a graded increase in all-cause and CVD- and CHD-specific mortality with increasing CAC dispersion.
AB - Coronary artery calcium (CAC) measures subclinical atherosclerosis and improves risk stratification. CAC characteristics—including vessel(s) involved, number of vessels, volume, and density—have been shown to differentially impact risk. We assessed how dispersion—either the number of calcified vessels or CAC phenotype (diffuse, normal, and concentrated)—impacted cause-specific mortality. The CAC Consortium is a retrospective cohort of 66,636 participants without coronary heart disease (CHD) who underwent CAC scoring. This study included patients with CAC >0 (n = 28,147). CAC area, CAC density, and CAC phenotypes (derived from the index of diffusion = 1 – [CAC in most concentrated vessel/total Agatston score]) were calculated. The associations between CAC characteristics and cause-specific mortality were assessed. The participant details included (n = 28,147): mean age 58.3 years, 25% female, 89.6% White, and 66% had 2+ calcified vessels. Diabetes, hypertension, and hyperlipidemia were predictors of multivessel involvement (p <0.001). After controlling for the overall CAC score, those with 4-vessel CAC involvement had more CAC area and less dense calcifications than those with 1-vessel. There was a graded increase in all-cause and cardiovascular disease (CVD)- and CHD-specific mortality as the number of calcified vessels increased. Among those with ≥2 vessels involved (n = 18,516), a diffuse phenotype was associated with a higher CVD-specific mortality and had a trend toward higher all-cause and CHD-specific mortality than a concentrated CAC phenotype. Diffuse CAC involvement was characterized by less dense calcification, more CAC area, multiple coronary vessel involvement, and presence of certain traditional risk factors. There is a graded increase in all-cause and CVD- and CHD-specific mortality with increasing CAC dispersion.
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U2 - 10.1016/j.amjcard.2022.12.014
DO - 10.1016/j.amjcard.2022.12.014
M3 - Article
C2 - 36645939
AN - SCOPUS:85146297579
VL - 191
SP - 76
EP - 83
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
ER -