Higher Coronary Artery Calcium Research Articles

Coronary Calcium Is Elevated in Patients with Myocardial Infarction without Standard Modifiable Risk Factors.

Objectives: Recent reports have highlighted myocardial infarction (MI) patients without standard modifiable risk factors (SMRF), noting them to be surprisingly common and to have a substantial risk of adverse outcomes. The objective of this study was to address the challenge of identifying at-risk patients without SMRF and providing preventive therapy. Methods: Patients presenting between 2001 and 2021 to Intermountain Health catheterization laboratories with a diagnosis of MI were included if they also had a coronary artery calcium (CAC) scan by computed tomography within 2 years. SMRF were defined as a clinical diagnosis or treatment of hypertension, hyperlipidemia, diabetes, or smoking. The co-primary endpoints in SMRF-less patients were: (1) proportion of patients with an elevated (>50%ile) CAC score, and (2) an indication for statin therapy (i.e., CAC ≥ 100 AU or ≥75%ile). The 60-day and long-term major adverse cardiovascular events were determined. A comparison set included MI patients with SMRF. Results: We identified 429 MI patients with a concurrent CAC scan, of which 60 had no SMRF. SMRF status did not distinguish most risk factors or interventions. No-SMRF patients had a high CAC prevalence and percentile (82% ≥ 50%ile; median, 80%ile), and 77% met criteria for preventive therapy. As expected, patients with SMRF had high CAC scores and percentiles. Outcomes were more favorable for No-SMRF status and for lower CAC scores. Conclusions: Patients without SMRF presenting with an MI have a high prevalence and percentile of CAC. Wider application of CAC scans, including in those without SMRF, is promising as a method to identify an additional at-risk population for MI and to provide primary preventive therapy.

Coronary artery calcification score as a prognostic indicator for COVID-19 mortality: evidence from a retrospective cohort study in Iran

Background: Coronary artery calcification (CAC) has been established as an independent risk factor for major adverse cardiovascular events. Nevertheless, the effect of CAC on in-hospital mortality and adverse clinical outcomes in patients with COVID-19 has yet to be determined. Objective: To investigate the association between CAC score and in-hospital mortality of COVID-19 patients Method: This retrospective cohort study was conducted across tertiary hospitals of University of Medical Sciences in Babol, a northern city in Iran, and enroled 551 confirmed COVID-19 patients with definitive clinical outcomes of death or discharge between March and October 2021. Demographic and clinical data, along with chest computed tomography (CT) findings and CAC score on admission, were systematically collected. The study utilized logistic regression analysis and Kaplan-Meier plots to explore the association between CAC score and in-hospital death and adverse clinical outcomes. Results: The mean age was 60.05±12.8. A significant difference regarding CAC score, age, history of hypertension, hyperlipidemia, cardiovascular diseases, and respiratory diseases among survivors and non-survivors was observed; however, gender was not found to be different. Furthermore, in multivariate analysis, CAC score greater than or equal to 400 [odds ratio (OR): 4.2, 95% CI: 1.70–10.33, P value: 0.002], hospitalization time (OR: 1.31, 95% CI: 1.13–1.53, P value < 0.001), length of ICU stay (OR: 2.02, 95% CI: 1.47–2.77, P value < 0.001), severe or critical COVID-19 severity in time of admission (95% CI: 1.79–18.29, P value: 0.003), and history of respiratory diseases (95% CI: 2.18–40, P value: 0.003) were found to be associated with higher odds of in-hospital mortality. Log-rank test also revealed a significant difference regarding the time of admission to death between patients with CAC score greater than or equal to 400 and those with CAC score less than 400 (P value < 0.001). Conclusion: Elevated CAC score is a crucial risk factor linked to in-hospital mortality and unfavourable clinical results in confirmed COVID-19 patients. This finding emphasizes the need for careful monitoring of individuals with high CAC scores.

The Value of Coronary Computed Tomography Angiography in Patients with a High Calcium Score.

We aimed to assess the agreement between coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) to determine whether patients with a high coronary artery calcium score (CS) would benefit from CCTA. This cross-sectional study was conducted on patients suspected of having coronary artery disease. The patients underwent calcium scoring. The total CS and the number of calcified foci were determined. The calcium score index (CSI) was defined, and coronary arteries were evaluated by CCTA. ICA was performed, and reports of ICA were extracted. All the abovementioned variables were compared. For data analysis, the κ coefficient and the ROC curve were used. The study population consisted of 195 patients: 124 men (63.6%) and 71 women (36.4%). The median (IQR) value of CS was 529 (229-1042), ranging from 17 to 4717. In all 195 patients, the concordance between the final impression of CCTA and ICA was 90.2%, while the number and type of involved territories were similar at 57.9%. The highest agreement was seen in the left main and right coronary arteries, whereas the lowest agreement was detected in the left anterior descending and the left circumflex artery. The patients were categorized into different CS groups, and in those with a high CS (>1000), the agreement between CCTA and ICA concerning final impression and involved territories was similar to the whole group of patients. CCTA in patients with a high CS, even exceeding 1000, remains beneficial as the noninvasive available method.

Incremental Value of ABI and CAC Beyond Traditional Risk Markers in Long-term Prediction of Cardiovascular Disease Incidence in Participants with Diabetes: Multi-Ethnic Study of Atherosclerosis

IntroductionPrimary prevention of cardiovascular disease (CVD) emphasizes detection of subclinical atherosclerosis (SA). Diabetes Mellitus is a high-CVD risk condition with higher prevalence of systemic atherosclerosis. Ankle brachial index (ABI) and coronary artery calcium (CAC) are commonly used measures to detect SA. The primary objective of this study was to evaluate the improvement in CVD risk prediction beyond traditional risk factors after adding ABI and CAC within diabetic participants. MethodsMESA is an observational cohort of 6,814 participants free of clinical cardiovascular disease at baseline. Participants were included in this analysis if they had diabetes or impaired fasting glucose. Cox proportional hazard regression was used to assess the association between CAC score and ABI and outcomes (incident CVD and all-cause mortality). We compared the C-index between a model with traditional risk factors alone and models including ABI and/or CAC. Results1,719 participants were included in the analysis. Average age was 64 years, 55% male, 25% White, 13% Chinese, 34% Black, and 27% Hispanic. Higher CAC and lower ABI were associated with higher risk of CVD (Figure 1) and mortality among people with diabetes. Both ABI and CAC improved CVD discrimination over and above standard risk factors (C-index 0.689 for risk factors alone, 0.719 for CAC, 0.696 for ABI, and 0.721 for both). Similarly for mortality, discrimination was improved over risk factors alone (C-index 0.739) for CAC (0.746), ABI (0.747), and both (0.748). ConclusionThese two subclinical atherosclerosis measures may aid in clinical decision making among those with diabetes.

Advanced glycation end products measured by skin autofluorescence and subclinical cardiovascular disease: the Rotterdam Study

BackgroundAdvanced glycation end products (AGEs) have been linked to cardiovascular disease (CVD), especially coronary heart disease (CHD), but their role in CVD pathogenesis remains unclear. Therefore, we investigated cross-sectional associations of skin AGEs with subclinical atherosclerosis, arterial stiffness, and hypertension after confirming their relation with CHD.MethodsIn the population-based Rotterdam Study, skin AGEs were measured as skin autofluorescence (SAF). Prevalent MI was obtained from digital medical records. Carotid plaques, carotid intima-media thickness (IMT), coronary artery calcification (CAC), pulse wave velocity (PWV), and hypertension were assessed. Associations of SAF with endophenotypes were investigated in logistic and linear regression models adjusting for common cardiovascular risk factors. Effect modification by sex, diabetes mellitus, and chronic kidney disease (CKD) was tested.Results3001 participants were included (mean age 73 (SD 9) years, 57% women). One unit higher SAF was associated with the presence of carotid plaques (OR 1.2 (0.92, 1.57)), a higher max IMT (0.08 SD (0.01, 0.15)), higher CAC (OR 2.2 (1.39, 3.48)), and PWV (0.09 SD (0.01, 0.16)), but not with hypertension (OR 0.99 (0.81, 1.21)). The associations with endophenotypes were more pronounced in men and participants with diabetes or CKD with significant interactions.ConclusionsPreviously documented associations between SAF and CVD, also found in our study, may be explained by the endophenotypes atherosclerosis and arterial stiffness, especially in men and individuals with diabetes or CKD, but not by hypertension. Longitudinal studies are needed to replicate these findings and to test if SAF is an independent risk factor or biomarker of CVD.Trial registration: The Rotterdam Study has been entered into the Netherlands National Trial Register (NTR; www.trialregister.nl) and the WHO International Clinical Trials Registry Platform (ICTRP; www.who.int/ictrp/network/primary/en/) under shared catalogue number NTR6831.

Prediction of high coronary artery calcium (CAC) scores from aortic arch calcification: An efficient tool for selection of non-optimal candidates for coronary CTA?

PurposeOverutilization of healthcare resources is causing a high socioeconomic burden. Patients with high coronary artery calcium (CAC) scores > 1000AU are not optimal candidates for coronary CTA and better suited for other diagnostic strategies. Therefore, our objective was to evaluate whether a 4-scale aortic arch calcification severity (AoArCa) score from CT and X-Ray predicts high-CAC scores. MethodsPatients referred to coronary/aortic CT-Angiography were enrolled. The severity of aortic arch calcification (AoArCa) was scored as grade: 0 = absent, 1 = minimal (<25 % of circumference), 2 = mild (25–50 %), 3 = moderate (50–75 %) and 4 = severe (75–100 %) on both thoracic CT and X-ray. ResultsIn 130 patients, the absence of AoArCa by CT was highly accurate to rule out CAC > 1000AU (sens. 100 %). No or minimal AoArCa had a high NPV of 95.6 % to rule out CAC > 1000 and grade 0,1 + 2 a NPV of 86.96 %.The AUC of AoArCa by CT for predicting high CAC > 1000 was c = 0.84 (p < 0.001; 95 %CI: 0.771––0.91). For moderate-to-severe AoArCa, accuracy was c = 0.792 (p < 0.001).The intermodality agreement between CT and X-Ray based AoArCa Scores was good (r = 0.824, p < 0.001); ICC = 0.902. For X-ray, AUC was c = 0.715 to predict CAC > 1000 (p < 0.001).In regression models, only moderate-or-severe AoArCa, but not the other CVRF predicted CAC > 1000 (p < 0.001), and there was an association of the number of CVRF. ConclusionsPatients with moderate-to-severe aortic arch calcification have a high probability of CAC > 1000AU, but not those with no, minimal and mild. The absence of AoArCa rules out CAC > 1000AU. AoArCa severity may serve as valuable tool for selecting the diagnostic strategy.

Eicosapentaenoic and docosahexaenoic acid supplementation and coronary artery calcium progression in patients with coronary artery disease: A secondary analysis of a randomized trial

Background and aimsWe previously reported that an omega-3 fatty acid index ≥4% with high-dose eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) prevented progression of noncalcified plaque. Higher coronary artery calcium (CAC) scores and progression of CAC are associated with increased cardiovascular events and mortality. We examined the effect of EPA + DHA on CAC score. MethodsA total of 242 patients with coronary artery disease (CAD) on statin therapy were randomized to 1.86 g EPA and 1.5 g DHA daily or none (control) for 30 months. The CAC score was measured at baseline and 30-months with non-contrast, cardiac computed tomography. ResultsBoth EPA + DHA and control groups had significant progression in CAC scores over 30 months (median change:183.5 vs 221.0, respectively, p < 0.001) despite a 13.6% reduction in triglyceride level with EPA + DHA. No significant difference was observed between groups for the total group, by baseline CAC scores of <100, 100–399, 400–999 and ≥1000 or quartiles of achieved levels of EPA, DHA and the omega-3 fatty acid index. Similar rates of CAC progression were noted in those on high-intensity statin compared to low- and moderate-intensity statin. ConclusionsEPA and DHA added to statin resulted in similar CAC progression over 30 months regardless of baseline CAC categories, statin intensity and achieved levels of EPA, DHA and the omega-3 fatty acid index.

In 2023 PET myocardial perfusion imaging is preferred to invasive coronary angiography for the initial work-up of a symptomatic patient with a high coronary artery calcium score.

In 2023 PET myocardial perfusion imaging is preferred to invasive coronary angiography for the initial work-up of a symptomatic patient with a high coronary artery calcium score.

Association of coronary artery calcification with mortality and myocardial injury after noncardiac surgery

Abstract Objectives This study aimed to evaluate the prognostic value of preoperative coronary artery calcium (CAC) scores for predicting in-hospital death and myocardial injury after noncardiac surgery (MINS). Backgrounds The CAC score is a surrogate marker for atherosclerosis and coronary artery disease. However, the association between preoperative CAC score and development of MINS has not been studied. Methods From 2010 to 2019, patients with CAC scores measured within three years prior to noncardiac surgery were enrolled from a tertiary hospital. Patients with a history of coronary revascularization were excluded from this study. The Agatston method was used to calculate CAC scores. The primary outcome was in-hospital death or MINS, defined as a peak high-sensitivity troponin I level higher than 0.040 ng/ml within 30 days after noncardiac surgery. The secondary outcome was 1-year mortality. Results A total of 740 patients were included in the analysis. The mean age was 67.0 years, and 68.9% were male. In-hospital death or MINS occurred in 129 (17.4 %) patients. The median CAC score was 164.0 and 70.5 in patients with and without in-hospital death or MINS, respectively (p=0.001). The preoperative CAC score was significantly associated with the development of in-hospital death or MINS (per 100 increases, odds ratio [OR] 1.05; 95% confidence interval [CI] 1.02–1.07). The best CAC score cutoff value for predicting in-hospital death or MINS was 619 (&amp;lt;619 vs. ≥619, OR 2.47; 95% CI 1.60–3.81; p&amp;lt;0.001), which was significant after adjustment for clinical risk factors. The 1-year mortality rate was significantly different according to CAC score strata. Conclusions A high preoperative CAC score was associated with a significant increase in in-hospital death or MINS independent of clinical risk factors.1-year mortality rate : CAC score1yr mortality rate by CAC score cut-off

Does prediabetes diagnosed by hemoglobinA1c or oral glucose tolerance test predict coronary artery disease in patients suspected of chronic coronary syndrome?

Abstract Introduction The presence of prediabetes worsens the prognosis of coronary artery disease, as patients with prediabetes are known to have an almost doubled cardiovascular mortality risk compared to normoglycemic patients. In clinical practice, HemoglobinA1c (HbA1c) has replaced the oral glucose tolerance test (OGTT) in the diagnosis of prediabetes. However, the background for the HbA1c threshold is based on the development of microvascular complications and progression to established diabetes. It remains unclear whether the substitution of OGTT with HbA1c results in an underestimation of prediabetics with a high risk of coronary artery disease, or if HbA1c is associated with macrovascular complications in prediabetic patients. Purpose We aimed to investigate whether HbA1c- or OGTT-diagnosed prediabetes could predict presence and severity of coronary artery disease in patients suspected of chronic coronary syndrome. Methods This was a descriptive cross-sectional study of 702 patients referred to a coronary CT angiography due to suspicion of chronic coronary syndrome. Coronary artery calcification (CAC)-score, presence of plaque and significant stenosis (&amp;gt;50%), and plaque characteristics were evaluated. All patients had a fasting OGTT and blood samples performed. Patients were categorized according to glycemic status by HbA1c and OGTT, and compared to their test-specific range. Results Prediabetes was detected by HbA1c 167 (24%) or OGTT 272 (39%), and an overlap in classification by both tests was seen in 98 (22%) of participants. Both classifications of prediabetes showed increased presence of plaques, significant stenosis, calcified plaques, and correspondingly, a low frequency of a CAC-score=0 compared to their test-specific normal. Additionally, the HbA1c-prediabetics had an increased frequency of a high CAC score &amp;gt;400 compared to normal HbA1c (23% vs. 10%, p&amp;lt;0.0001). In the multiple logistic regression analysis the HbA1c-prediabetics had an odds ratio (OR) of 1.5 for plaque presence (confidence interval (CI) 1.0;2.4) and OR 2.1 for a CAC-score &amp;gt;400 (CI 1.3;3.5). None of the associations for the OGTT-prediabetics were significant in the logistic regression analysis. Receiver operating characteristic curves were applied to the significant logistic associations. The HbA1c-prediabetics had an area under the curve (AUC)=0.77 for plaque presence and AUC=0.81 for CAC-score &amp;gt;400. Conclusion Prediabetes defined by HbA1c can predict presence and severity of coronary artery disease. Although OGTT identified more patients as having prediabetes, their risk of coronary artery disease was not attributable to prediabetes. Thus, our results support the replacement of OGTT with HbA1c in clinical practice.

Prevalence of subclinical coronary artery atherosclerosis in the general population- apollo subclinical coronary atherosclerosis project (ASCAP)

Abstract Background Coronary artery disease (CAD) is a major cause of mortality and morbidity in our country. CAD affects Indian population at least a decade earlier than the people of European ancestry, often impacting the most productive years of an individual’s life. CAD is often silent or may strike without warning, underscoring the importance of prevention. We used computerized tomography (CT) coronary angiography (CT-CAG) to determine the prevalence, severity, and characteristics of CAD and its association with coronary artery calcium (CAC) scores in general population. Purpose Detection of coronary atherosclerosis using CT-CAG, in addition to CAC score, may help in early preventive strategies. In doing so, we can identify population at risk at an early stage and manage them accordingly either by lifestyle modifications, medications or if needed further intervention. Methods This study included 451 individuals aged 40 years and above with no known CAD (no previous myocardial infarction or cardiac procedures) and with high-quality results from CT-CAG. Non-contrast images were used for calculating CAC score. CT-CAG was reported per segment, defined as- no atherosclerosis, 1% to 49% stenosis (insignificant atherosclerosis), or ≥50% stenosis (significant atherosclerosis). Results Out of the 451 individuals, 72% were men and 27.9% were women. Any CT-CAG detected atherosclerosis was found in 60%; any significant stenosis (≥50%) in 27.7%; no stenosis in 39.9% and any noncalcified plaque &amp;lt;50% in 32.3% of this population. (Table 1) Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending (LAD) artery. Prevalence of CT-CAG detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score &amp;gt;400, all the individuals had atherosclerosis and 95.8% had significant stenosis. In those with zero CAC score, 59.4% had no atherosclerosis and 7.5% had significant stenosis. (Table 2) Conclusion Using CT-CAG in a large sample of the general population without CAD, has shown that silent coronary atherosclerosis is more common than expected. High CAC scores convey a significant probability of substantial stenosis, and zero CAC score does not exclude atherosclerosis, particularly in those at higher baseline risk.

Abstract 12423: CAD Polygenic Risk Score, a Novel Screening Tool for Predicting Likelihood of Coronary Artery Disease, Was Not Superior to Coronary Calcium Score in Predicting MACE

Introduction: Coronary artery calcium (CAC) score is a well-established tool for risk assessment of coronary artery disease (CAD). Alternatively, CAD polygenic risk score (PRS) is an emerging modality for assessing risk of CAD. Our study aims to compare the sensitivity and specificity of the above scores in predicting major adverse cardiovascular events (MACE). Hypothesis: CAD PRS is a better predictor of MACE than CAC score. Methods: Adult patients had CAD PRS, CAC and baseline characteristics documented through the Sanford Heart Screening Program from 2011 to 2021. Incidence of MACE, defined as myocardial infarction, stroke, death, and revascularization, was analyzed. Chi-squared tests were used to examine the impact of stratified risk scores and MACE. A logistic regression model was trained on 70% of the data to assess prediction accuracy on 30% of the data. Results: A total of 1,380 patients were analyzed. Mean age was 63, with female (65%) and Caucasian (99%) predominance. The prevalence of diabetes mellitus, hyperlipidemia, and hypertension was 8%, 32%, and 7%, respectively. The incidence of MACE was 6.6%. Patients with MACE had higher CAC (527.1±856.2 vs. 98.3±294.3) and CAD PRS (15.5±.62 vs. 15.24±.61). Sensitivity and specificity are represented by the receiver operating characteristic curve, which was used to assess prediction accuracy whereby area under the curve (AUC) was used as a measure of fit ranging from 0 to 1. The curves showed that CAC had better AUC than PRS (Figure 1). Conclusions: In our study CAD PRS failed to be a better predictor of MACE compared to CAC score.

Abstract 16044: Coronary Artery Calcium Score, a Superior Predictor of Cardiac Revascularization Risk Than Framingham

Introduction: The coronary artery calcium (CAC) score is a powerful independent screening tool for coronary artery disease (CAD). Elevated CAC score has been significantly associated with increased rates of revascularization, however the Framingham Risk Score remains the most used method of predicting patients’ risk for future revascularization. Hypothesis: The CAC score is a superior predictor of adverse cardiac events than the traditionally accepted Framingham Risk Score. Methods: Data was analyzed retrospectively of patients who underwent calcium score scans between August 2011 and April 2021 as part of the Sanford Cardiovascular Prevention Program and were categorized into low (&lt;100), moderate (100-399), or high (≥400) CAC groups. The accuracy of revascularization prediction between subjects with CAC score and those without CAC score were evaluated by a ROC curve. Results: A total of 28,187 patients were screened for CAC score. 46% were females and the mean age was 61.4 ± 9.9 years. ROC predictive accuracy of patients with CAC scores (0.76) compared against those with no CAC score (0.71) was found to be statistically significant (Z = -6.27, P&lt;0.01). Furthermore, total CAC was found to a significant predictor (b=.001, p&lt;0.01) of revascularization above and beyond the additional risk factors with the pseudo R2 increasing from .08 for starting risk factors to .15 when total CAC was added for a pseudo R2 change of .07 Conclusions: In our study, CAC scoring was not only able to better predict the need for future revascularization compared to Framingham components but also able to improve the specificity of revascularization prediction when added to the Framingham components.

In 2023 invasive coronary angiography is preferred to PET myocardial perfusion imaging for the initial work-up of a symptomatic patient with a high coronary artery calcium score.

In 2023 invasive coronary angiography is preferred to PET myocardial perfusion imaging for the initial work-up of a symptomatic patient with a high coronary artery calcium score.

Association Between Coronary Artery Calcium Score and Left Ventricular Diastolic Dysfunction in Patients with Hypertension

Background: Left ventricular diastolic dysfunction (LVDD) and coronary artery calcium (CAC) are common in patients with hypertension and are strong predictors of cardiovascular events. Aim: This study aims to investigate the association between CAC and LVDD in patients with hypertension without coronary artery disease (CAD). Methods: Consecutive patients with hypertension who underwent echocardiography and non-contrast coronary CT were studied. CAC was quantified using the Agatston score. Patients with a history of CAD, AF or left ventricular ejection fraction (LVEF) &lt;50% were excluded. Characteristics of patients with and without LVDD were compared and the association between LVDD and CAC was evaluated. Univariable and multivariable analyses were performed to determine the predictors of LVDD and high CAC (&gt;median CAC). A p value of &lt;0.05 was considered statistically significant. Results: A total of 250 patients were included, with a mean age of 64.3 ± 10.1 years, 59% women and 26.4% had diabetes. The prevalence of LVDD was 64.8% (grade I LVDD 48%; grade II LVDD 16.8%) and the median CAC score was 58.2 (interquartile range [IQR] 0.7–349.8). Patients with LVDD had a significantly higher median CAC score than those without LVDD (142.8 [IQR 18.8–514.8] versus 5.0 [IQR 0–64.4]; p&lt;0.001). Multivariable analysis showed that the CAC score was independently associated with LVDD (OR 1.003; 95% CI [1.001–1.004]; p&lt;0.001). Left atrial volume index and E-wave deceleration time were independently associated with high CAC (OR 1.05; 95% CI [1.01–1.09]; p=0.008 and OR 1.008; 95% CI [1.002–1.02]; p=0.01), respectively. Conclusion: CAC scoring was associated with LVDD in patients with hypertension.

Prognostic Value of Coronary CT Angiography-derived Fractional Flow Reserve on 3-year Outcomes in Patients with Stable Angina.

Background The prognostic value of coronary CT angiography (CTA)-derived fractional flow reserve (FFR) beyond 1-year outcomes and in patients with high levels of coronary artery calcium (CAC) is uncertain. Purpose To assess the prognostic value of coronary CTA-derived FFR test results on 3-year clinical outcomes in patients with coronary stenosis and among a subgroup of patients with high levels of CAC. Materials and Methods This study represents a 3-year follow-up of patients with new-onset stable angina pectoris who were consecutively enrolled in the Assessing Diagnostic Value of Noninvasive CT-FFR in Coronary Care, known as ADVANCE (ClinicalTrials.gov: NCT02499679) registry, between December 2015 and October 2017 at three Danish sites. A high CAC was defined as an Agatston score of at least 400. A lesion-specific coronary CTA-derived FFR value of 2 cm with distal-to-stenosis value at or below 0.80 represented an abnormal test result. The primary end point was a composite of all-cause death and nonfatal spontaneous myocardial infarction. Event rates were estimated using the one-sample binomial model, and relative risk was compared between participants stratified by results of coronary CTA-derived FFR. Results This study included 900 participants: 523 participants with normal results (mean age, 64 years ± 9.6 [SD]; 318 male participants) and 377 with abnormal results from coronary CTA-derived FFR (mean age, 65 years ± 9.6; 264 male participants). The primary end point occurred in 11 of 523 (2.1%) and 25 of 377 (6.6%) participants with normal and abnormal coronary CTA-derived FFR results, respectively (relative risk, 3.1; 95% CI: 1.6, 6.3; P < .001). In participants with high CAC, the primary end point occurred in four of 182 (2.2%) and 19 of 212 (9.0%) participants with normal and abnormal coronary CTA-derived FFR results, respectively (relative risk, 4.1; 95% CI: 1.4, 11.8; P = .001). Conclusion In individuals with stable angina, a normal coronary CTA-derived FFR test result identified participants with a low 3-year risk of all-cause death or nonfatal spontaneous myocardial infarction, both in the overall cohort and in participants with high CAC scores. Clinical trial registration no. NCT02499679 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Sinitsyn in this issue.

Is coronary artery calcium an independent risk factor for white matter hyperintensity?

BackgroundCardiovascular diseases have been considered the primary cause of disability and death worldwide. Coronary artery calcium (CAC) is an important indicator of the severity of coronary atherosclerosis. This study is aimed to investigate the relationship between CAC and white matter hyperintensity (WMH) in the context of diagnostic utility.MethodsA retrospective analysis was conducted on 342 patients with a diagnosis of WMH on magnetic resonance images (MRI) who also underwent chest computed tomography (CT) scans. WMH volumes were automatically measured using a lesion prediction algorithm. Subjects were divided into four groups based on the CAC score obtained from chest CT scans. A multilevel mixed-effects linear regression model considering conventional vascular risk factors assessed the association between total WMH volume and CAC score.ResultsOverall, participants with coronary artery calcium (CAC score > 0) had larger WMH volumes than those without calcium (CAC score = 0), and WMH volumes were statistically different between the four CAC score groups, with increasing CAC scores, the volume of WMH significantly increased. In the linear regression model 1 of the high CAC score group, for every 1% increase in CAC score, the WMH volume increases by 2.96%. After including other covariates in model 2 and model 3, the β coefficient in the high CAC group remains higher than in the low and medium CAC score groups.ConclusionIn elderly adults, the presence and severity of CAC is related to an increase in WMH volume. Our findings suggest an association between two different vascular bed diseases in addition to traditional vascular risk factors, possibly indicating a comorbid mechanism.

Association of silent myocardial infarction on electrocardiogram and coronary artery calcium: The Multi-Ethnic Study of Atherosclerosis.

Silent myocardial infarction (SMI) on electrocardiogram (ECG) is associated with atherosclerotic cardiovascular disease, but the relationship between SMI on ECG and coronary artery calcium (CAC) remains poorly understood. Characterize the relationship between SMI on ECG and CAC. Eligible participants from the Multi-Ethnic Study of Atherosclerosis study had ECG and CAC scoring at study enrollment (2000-2002). SMI was defined as ECG evidence of myocardial infarction in the absence of a history of clinical cardiovascular disease. CAC was modeled both continuously and categorically. The cross-sectional relationships between SMI on ECG and CAC were assessed using logistic regression and linear regression. Among 6705 eligible participants, 178 (2.7%) had baseline SMI. Compared to participants without SMI, those with SMI had higher CAC (median [IQR]: 61.2 [0-261.7] vs. 0 [0-81.5]; p < .0001). Participants with SMI were more likely to have non-zero CAC (74% vs. 49%) and were more likely to have CAC ≥ 100 (40% vs. 23%). In a multivariable-adjusted logistic model, SMI was associated with higher odds of non-zero CAC (odds ratio 2.17, 95% CI 1.48-3.20, p < .0001) and 51% higher odds of CAC ≥ 100 (odds ratio 1.51, 95% CI 1.06-2.16, p = .02). An incidental finding of SMI on ECG may serve to identify patients who have a higher odds of significant CAC and may benefit from additional risk stratification to further refine their cardiovascular risk. Further exploration of the utility of CAC assessment in this patient population is needed.

The novel H2VK-65 clinical risk assessment tool predicts high coronary artery calcium score in symptomatic patients referred for coronary computed tomography angiography.

Coronary computed tomographic angiography (CCTA) has emerged as a powerful imaging modality for the detection and prognostication of individuals with suspected coronary artery disease (CAD). High amounts of coronary artery calcium (CAC) significantly obscure the interpretation of CCTA. Clinical risk assessment tools and data specific to predictors of high CAC in symptomatic patients are limited. Consecutive patients who underwent CAC scan and CCTA to diagnose CAD during 2016-2020 were included. A high CAC score was defined as >400 by Agatston method. Univariate and multivariate analyses were performed to determine the predictors of high CAC. The clinical risk score was derived from factors independently associated with high CAC. The derivation cohort was composed of 465 patients; this score was validated in 98 patients. The mean age was 63 ± 11 years, 53% were female, and 15.9% had high CAC scores. The independent predictors of high CAC scores were age >65 years (odds ratio [OR] 3.02, 95% confidence interval (95%CI) 1.56-5.85, p = 0.001), chronic kidney disease (CKD) (OR 11.09, 95%CI 3.38-36.38, p < 0.001), heart failure (OR 6.52, 95%CI 2.23-19.09, p = 0.001), hypertension (OR 26.44, 95%CI 9.02-77.44, p < 0.001), and vascular diseases, including ischemic stroke/transient ischemic attack and peripheral arterial disease (OR 20.96, 95%CI 4.19-104.86, p < 0.001). The H2VK-65 (Hypertension, Heart failure, Vascular diseases, CKD, and Age > 65) score allocates 1 point for age >65, 2 points for CKD or heart failure, and 3 points for hypertension or vascular diseases. Using a threshold of ≥4 points, the sensitivity and specificity to detect high CAC was 81% and 80%, respectively. The area under the curve was 0.88 and 0.85 in the derivation and validation cohorts, respectively. The novel H2VK-65 score demonstrated good performance for predicting high CAC scores in symptomatic patients referred for CCTA.

Incremental value of ABI and CAC beyond traditional risk markers in long-term prediction of cardiovascular disease incidence in participants with diabetes and impaired fasting glucose: Multi-Ethnic Study of Atherosclerosis

Background and aimsSubclinical atherosclerosis (SA) diagnosis is key to primary prevention of atherosclerotic cardiovascular disease (ASCVD). SA is common among diabetics. Ankle brachial index (ABI) and coronary artery calcium (CAC) are markers of SA. This study examined whether adding ABI and CAC to diabetic individuals improved ASCVD risk prediction beyond established risk factors. MethodsMESA is an observational cohort of 6814 participants without clinical cardiovascular disease. All participants with diabetes and impaired fasting glucose were included in the analysis. The association between CAC, ABI, and incident ASCVD, and all-cause mortality was examined using Cox proportional hazard regression. The risk prediction models including ABI and/or CAC in addition to standard risk factors alone were compared. ResultsOf the 1719 participants, 55% were male and average age was 64 (±9.6) years old. Participants with diabetes or impaired fasting glucose with higher CAC and lower ABI had higher ASCVD and all-cause mortality. ABI and CAC enhanced ASCVD discrimination over standard risk factors, with C-index (95% CI) of 0.689 (0.66, 0.718) for risk factors alone, 0.696 (0.668, 0.724) for ABI, 0.719 (0.691, 0.747) for CAC, and 0.721 (0.693, 0.749) for CAC + ABI. Similarly, for all-cause mortality, both CAC and ABI improved risk discrimination in addition to standard risk factors alone. ConclusionsIn a large population-based study of individuals with diabetes or impaired fasting glucose, the addition of ABI and CAC to conventional risk factors improved 10-year ASCVD risk prediction. ABI and CAC are non-invasive and cost-effective tests; therefore, these markers should be included into ASCVD risk stratification for primary prevention in the diabetic and impaired fasting glucose population.