Coronary artery calcium score is a predictive tool for cardiovascular events in an asymptomatic population

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Abstract Background Recent research highlights the role of the coronary artery calcium score (CAC Score) in evaluating the severity of subclinical atherosclerosis in asymptomatic individuals without apparent cardiovascular disease (CVD). However, the influence of the CAC score on the prognosis of an asymptomatic population is not consensual. Objective Investigate the role of the CAC score as a predictive tool for the occurrence of cardiovascular events in an asymptomatic population without known CVD. Methods 1195 asymptomatic subjects (mean age 55.1±6.9 years, 73.8% male) selected from the prospective arm of the GENEMACOR study were followed up during 5.9±4.3 years. CAC score was performed by cardiac computed tomography and reported as Agatston units according to the Hoff Nomogram in low, moderate and high-risk categories. The bivariate analysis evaluated CV events in the three CAC score risk categories and in traditional risk factors (TRFs) individually. Multivariable Cox proportional hazard ratios (HR) with 95% confidence intervals (95% CI) assessed the variables independently associated with CV events occurrence. Kaplan-Meier estimated the survival in the CAC risk categories. Results None of the TRFs showed significant differences in the CV events percentages. As the CAC score category increases, the percentage of CV events rises (p<0.0001). After Cox regression analysis, the high CAC risk category remained a strong CV events predictor (HR=3.71; 95% CI 1.66-8.27; p=0.001), along with age and smoking (Table). At fifteen years of follow-up, 95.3%, 92.8%, and 84.3% survived in the low, moderate and high-risk categories, respectively (Long Rank test; p<0.0001). Conclusion The presence of coronary calcifications indicated a worse prognosis in our asymptomatic population. CAC score is an excellent predictive tool for the asymptomatic subjects with coronary atherosclerosis in progression and could help initiate preventive therapy.