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Publications

Journal Article Ahead of print

PubMed: 42861496 DOI: 10.1161/CIRCIMAGING.126.020112

Development and Validation of a Coronary Artery Calcium Volume and Density Score.

Circ Cardiovasc Imaging

Authors: Harpreet S Bhatia, Alexander C Razavi, Zeina Dardari, Robyn L McClelland, David R Jacobs, James G Terry, J Jeffrey Carr, Daniel Duprez, Parag H Joshi, Anand Rohatgi, Amit Khera, Jamal S Rana, Ankeet Bhatt, Tara S Allen, Julie Denenberg, Matthew Budoff, Matthew Allison, Michael J Blaha, Michael Criqui

Affiliations

  • Division of Cardiology, Department of Medicine, University of California San Diego Health, La Jolla (H.S.B. M.C.).
  • Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA (A.C.R.).
  • Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (Z.D. M.J.B.).
  • Department of Biostatistics, University of Washington, Seattle (R.L.M.).
  • Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (D.R.J.).
  • Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (J.G.T. J.J.C.).
  • Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (D.D.).
  • Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (P.H.J. A.R. A.K.).
  • Department of Cardiology, Kaiser Permanente Oakland Medical Center, CA (J.S.R.).
  • Department of Cardiology, Kaiser Permanente San Francisco Medical Center, CA (A.B.).
  • Division of Cardiovascular Medicine, Stanford School of Medicine, Palo Alto, CA (A.B.).
  • Department of Medicine, San Diego VA Healthcare System, La Jolla, CA (T.S.A.).
  • Division of Preventive Medicine, Department of Family Medicine, University of California, San Diego, La Jolla (J.D. M.A. M.C.).
  • Division of Cardiology, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA (M.B.).

Abstract

BACKGROUND

Coronary artery calcium (CAC) scoring is a useful tool for coronary heart disease (CHD) risk prediction. The current standard method, the Agatston score, weights plaque area upward by density. However, higher density is inversely associated with CHD. We aimed to develop and validate a CAC score accounting for the inverse association of density with CHD, and the nonlinear association between CAC volume and density in a prospective cohort study.

METHODS

A CAC volume and density score was developed, which adjusts CAC volume for density based on whether the volume level was <130 mm 3. We used data from the MESA (Multi-Ethnic Study of Atherosclerosis) to develop and assess the score, including all participants with CAC>0 and follow-up for CHD events. Score performance for CHD risk prediction was compared with the pooled cohort equations and the Agatston score using Cox proportional hazards models and Harrell C-index and continuous and categorical net reclassification improvement. Analyses were also stratified by Agatston score, age, sex, race/ethnicity, and statin use. Finally, performance was evaluated in 4 longitudinal cohorts for external validation.

RESULTS

The MESA cohort included 3360 individuals. CAC volume and density score improved the C-index for CHD to a greater degree over the pooled cohort equation (0.699 [95% CI, 0.675-0.723]) compared with the Agatston score (0.687 [95% CI, 0.663-0.711]) and resulted in greater continuous net reclassification improvement (0.54 [95% CI, 0.43-0.64]) compared with the Agatston score (0.45 [95% CI, 0.34-0.56]) when added to the pooled cohort equation. The greatest improvement in risk prediction was in those with lower burden of CAC (Agatston <300). Consistent results were seen in stratified analyses and external validation cohorts.

CONCLUSIONS

The CAC volume and density score, which adjusts CAC volume downward for higher density, and can be calculated from existing CAC reports, significantly improves risk discrimination and reclassification compared with the Agatston score.

MeSH

Cardiovascular Diseases, Blood Pressure, Aspirin, Arteries, Diagnostic Imaging, Calcium, Primary Prevention, Demography