Coronary Artery Calcium Distribution Is an Independent Predictor of Incident Major Coronary Heart Disease Events: Results From the Framingham Heart Study

Maros Ferencik, Karol M. Pencina, Ting Liu, Khristine Ghemigian, Kristin Baltrusaitis, Joseph M. Massaro, Ralph B. D'Agostino, Christopher J. O'Donnell, Udo Hoffmann

    Research output: Contribution to journalArticle

    19 Citations (Scopus)

    Abstract

    BACKGROUND: The presence and extent of coronary artery calcium (CAC) are associated with increased risk for cardiovascular events. We determined whether information on the distribution of CAC and coronary dominance as detected by cardiac computed tomography were incremental to traditional Agatston score (AS) in predicting incident major coronary heart disease (CHD).

    METHODS AND RESULTS: We assessed total AS and the presence of CAC per coronary artery, per segment, and coronary dominance by computed tomography in participants from the offspring and third-generation cohorts of the Framingham Heart Study. The primary outcome was major CHD (myocardial infarction or CHD death). We performed multivariable Cox proportional hazards analysis and calculated relative integrated discrimination improvement. In 1268 subjects (mean age, 56.2±10.3 years, 63.2% men) with AS >0 and no history of major CHD, a total of 42 major CHD events occurred during median follow-up of 7.4 years. The number of coronary arteries with CAC (hazard ratio, 1.68 per artery; 95% confidence interval, 1.10-2.57; P=0.02) and the presence of CAC in the proximal dominant coronary artery (hazard ratio, 2.59; 95% confidence interval, 1.15-5.83; P=0.02) were associated with major CHD events after multivariable adjustment for Framingham risk score and categories of AS. In addition, measures of CAC distribution improved discriminatory capacity for major CHD events (relative integrated discrimination improvement, 0.14).

    CONCLUSIONS: Distribution of coronary atherosclerosis, especially CAC in the proximal dominant coronary artery and an increased number of coronary arteries with CAC, predict major CHD events independently of the traditional AS in community-dwelling men and women.

    Original languageEnglish (US)
    JournalCirculation. Cardiovascular imaging
    Volume10
    Issue number10
    DOIs
    StatePublished - Oct 1 2017

    Fingerprint

    Coronary Disease
    Coronary Vessels
    Calcium
    Tomography
    Confidence Intervals
    Independent Living
    Risk Adjustment
    Information Dissemination
    Coronary Artery Disease
    Arteries
    Myocardial Infarction

    Keywords

    • atherosclerosis
    • coronary angiography
    • coronary artery disease
    • coronary disease
    • epidemiology

    ASJC Scopus subject areas

    • Radiology Nuclear Medicine and imaging
    • Cardiology and Cardiovascular Medicine

    Cite this

    Coronary Artery Calcium Distribution Is an Independent Predictor of Incident Major Coronary Heart Disease Events : Results From the Framingham Heart Study. / Ferencik, Maros; Pencina, Karol M.; Liu, Ting; Ghemigian, Khristine; Baltrusaitis, Kristin; Massaro, Joseph M.; D'Agostino, Ralph B.; O'Donnell, Christopher J.; Hoffmann, Udo.

    In: Circulation. Cardiovascular imaging, Vol. 10, No. 10, 01.10.2017.

    Research output: Contribution to journalArticle

    Ferencik, Maros ; Pencina, Karol M. ; Liu, Ting ; Ghemigian, Khristine ; Baltrusaitis, Kristin ; Massaro, Joseph M. ; D'Agostino, Ralph B. ; O'Donnell, Christopher J. ; Hoffmann, Udo. / Coronary Artery Calcium Distribution Is an Independent Predictor of Incident Major Coronary Heart Disease Events : Results From the Framingham Heart Study. In: Circulation. Cardiovascular imaging. 2017 ; Vol. 10, No. 10.
    @article{4346dd8b8b534abcaba3ee438bf5f72b,
    title = "Coronary Artery Calcium Distribution Is an Independent Predictor of Incident Major Coronary Heart Disease Events: Results From the Framingham Heart Study",
    abstract = "BACKGROUND: The presence and extent of coronary artery calcium (CAC) are associated with increased risk for cardiovascular events. We determined whether information on the distribution of CAC and coronary dominance as detected by cardiac computed tomography were incremental to traditional Agatston score (AS) in predicting incident major coronary heart disease (CHD).METHODS AND RESULTS: We assessed total AS and the presence of CAC per coronary artery, per segment, and coronary dominance by computed tomography in participants from the offspring and third-generation cohorts of the Framingham Heart Study. The primary outcome was major CHD (myocardial infarction or CHD death). We performed multivariable Cox proportional hazards analysis and calculated relative integrated discrimination improvement. In 1268 subjects (mean age, 56.2±10.3 years, 63.2{\%} men) with AS >0 and no history of major CHD, a total of 42 major CHD events occurred during median follow-up of 7.4 years. The number of coronary arteries with CAC (hazard ratio, 1.68 per artery; 95{\%} confidence interval, 1.10-2.57; P=0.02) and the presence of CAC in the proximal dominant coronary artery (hazard ratio, 2.59; 95{\%} confidence interval, 1.15-5.83; P=0.02) were associated with major CHD events after multivariable adjustment for Framingham risk score and categories of AS. In addition, measures of CAC distribution improved discriminatory capacity for major CHD events (relative integrated discrimination improvement, 0.14).CONCLUSIONS: Distribution of coronary atherosclerosis, especially CAC in the proximal dominant coronary artery and an increased number of coronary arteries with CAC, predict major CHD events independently of the traditional AS in community-dwelling men and women.",
    keywords = "atherosclerosis, coronary angiography, coronary artery disease, coronary disease, epidemiology",
    author = "Maros Ferencik and Pencina, {Karol M.} and Ting Liu and Khristine Ghemigian and Kristin Baltrusaitis and Massaro, {Joseph M.} and D'Agostino, {Ralph B.} and O'Donnell, {Christopher J.} and Udo Hoffmann",
    year = "2017",
    month = "10",
    day = "1",
    doi = "10.1161/CIRCIMAGING.117.006592",
    language = "English (US)",
    volume = "10",
    journal = "Circulation. Cardiovascular imaging",
    issn = "1941-9651",
    publisher = "Lippincott Williams and Wilkins",
    number = "10",

    }

    TY - JOUR

    T1 - Coronary Artery Calcium Distribution Is an Independent Predictor of Incident Major Coronary Heart Disease Events

    T2 - Results From the Framingham Heart Study

    AU - Ferencik, Maros

    AU - Pencina, Karol M.

    AU - Liu, Ting

    AU - Ghemigian, Khristine

    AU - Baltrusaitis, Kristin

    AU - Massaro, Joseph M.

    AU - D'Agostino, Ralph B.

    AU - O'Donnell, Christopher J.

    AU - Hoffmann, Udo

    PY - 2017/10/1

    Y1 - 2017/10/1

    N2 - BACKGROUND: The presence and extent of coronary artery calcium (CAC) are associated with increased risk for cardiovascular events. We determined whether information on the distribution of CAC and coronary dominance as detected by cardiac computed tomography were incremental to traditional Agatston score (AS) in predicting incident major coronary heart disease (CHD).METHODS AND RESULTS: We assessed total AS and the presence of CAC per coronary artery, per segment, and coronary dominance by computed tomography in participants from the offspring and third-generation cohorts of the Framingham Heart Study. The primary outcome was major CHD (myocardial infarction or CHD death). We performed multivariable Cox proportional hazards analysis and calculated relative integrated discrimination improvement. In 1268 subjects (mean age, 56.2±10.3 years, 63.2% men) with AS >0 and no history of major CHD, a total of 42 major CHD events occurred during median follow-up of 7.4 years. The number of coronary arteries with CAC (hazard ratio, 1.68 per artery; 95% confidence interval, 1.10-2.57; P=0.02) and the presence of CAC in the proximal dominant coronary artery (hazard ratio, 2.59; 95% confidence interval, 1.15-5.83; P=0.02) were associated with major CHD events after multivariable adjustment for Framingham risk score and categories of AS. In addition, measures of CAC distribution improved discriminatory capacity for major CHD events (relative integrated discrimination improvement, 0.14).CONCLUSIONS: Distribution of coronary atherosclerosis, especially CAC in the proximal dominant coronary artery and an increased number of coronary arteries with CAC, predict major CHD events independently of the traditional AS in community-dwelling men and women.

    AB - BACKGROUND: The presence and extent of coronary artery calcium (CAC) are associated with increased risk for cardiovascular events. We determined whether information on the distribution of CAC and coronary dominance as detected by cardiac computed tomography were incremental to traditional Agatston score (AS) in predicting incident major coronary heart disease (CHD).METHODS AND RESULTS: We assessed total AS and the presence of CAC per coronary artery, per segment, and coronary dominance by computed tomography in participants from the offspring and third-generation cohorts of the Framingham Heart Study. The primary outcome was major CHD (myocardial infarction or CHD death). We performed multivariable Cox proportional hazards analysis and calculated relative integrated discrimination improvement. In 1268 subjects (mean age, 56.2±10.3 years, 63.2% men) with AS >0 and no history of major CHD, a total of 42 major CHD events occurred during median follow-up of 7.4 years. The number of coronary arteries with CAC (hazard ratio, 1.68 per artery; 95% confidence interval, 1.10-2.57; P=0.02) and the presence of CAC in the proximal dominant coronary artery (hazard ratio, 2.59; 95% confidence interval, 1.15-5.83; P=0.02) were associated with major CHD events after multivariable adjustment for Framingham risk score and categories of AS. In addition, measures of CAC distribution improved discriminatory capacity for major CHD events (relative integrated discrimination improvement, 0.14).CONCLUSIONS: Distribution of coronary atherosclerosis, especially CAC in the proximal dominant coronary artery and an increased number of coronary arteries with CAC, predict major CHD events independently of the traditional AS in community-dwelling men and women.

    KW - atherosclerosis

    KW - coronary angiography

    KW - coronary artery disease

    KW - coronary disease

    KW - epidemiology

    UR - http://www.scopus.com/inward/record.url?scp=85031001930&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=85031001930&partnerID=8YFLogxK

    U2 - 10.1161/CIRCIMAGING.117.006592

    DO - 10.1161/CIRCIMAGING.117.006592

    M3 - Article

    C2 - 28956774

    AN - SCOPUS:85031001930

    VL - 10

    JO - Circulation. Cardiovascular imaging

    JF - Circulation. Cardiovascular imaging

    SN - 1941-9651

    IS - 10

    ER -