Coronary Artery Calcium for Risk Stratification of Sudden Cardiac Death: The Coronary Artery Calcium Consortium

Alexander C. Razavi, S. M.Iftekhar Uddin, Zeina A. Dardari, Daniel S. Berman, Matthew J. Budoff, Michael D. Miedema, Albert D. Osei, Olufunmilayo H. Obisesan, Khurram Nasir, Alan Rozanski, John A. Rumberger, Leslee J. Shaw, Laurence S. Sperling, Seamus P. Whelton, Martin Bødtker Mortensen, Michael J. Blaha, Omar Dzaye

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1259-1270
Number of pages12
JournalJACC: Cardiovascular Imaging
Issue number7
StatePublished - Jul 2022


  • cardiovascular diseases
  • coronary artery calcium
  • multidetector computed tomography
  • sudden cardiac death
  • Predictive Value of Tests
  • Calcium
  • Risk Assessment
  • Humans
  • Middle Aged
  • Risk Factors
  • Death, Sudden, Cardiac/epidemiology
  • Male
  • Coronary Artery Disease/complications
  • Female
  • Vascular Calcification

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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