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Am J Cardiol. 2019 May 1;123(9):1435-1442. doi: 10.1016/j.amjcard.2019.01.055. Epub 2019 Feb 10.

The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry).

Author information

1
Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York; Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Hanyang University Medical Center, Goyang-si, South Korea; Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
2
Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York; Department of Radiology, Mayo Clinic, Rochester, Minnesota.
3
Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York.
4
Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York; Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
5
Department of Imaging, Cedars Sinai Medical Center, Los Angeles, California.
6
Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York.
7
Tennessee Heart and Vascular Institute, Hendersonville, Tennessee.
8
Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, California.
9
Capitol Cardiology Associates, Albany, New York.
10
Department of Radiology and Nuclear Medicine, German Heart Center, Munich, Germany.
11
Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany.
12
Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
13
Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, California.
14
Department of Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland.
15
Department of Cardiology, William Beaumont Hospital, Royal Oak, Michigan.
16
Cardiovascular Imaging Center, Department of Radiology, SDN IRCCS, Naples, Italy.
17
Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy.
18
Department of Cardiology, Walter Reed National Military Medical Center, Bethesda, Maryland.
19
Seoul National University Hospital, Seoul, South Korea.
20
Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
21
Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
22
Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy.
23
UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal.
24
Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
25
Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremburg, Erlangen, Germany.
26
Department of Medicine and Radiology, University of Ottawa, Ottawa, Ontario, Canada.
27
Department of Radiology, Miami Cardiac and Vascular Institute, Miami, Florida, USA.
28
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
29
Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
30
Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, New York. Electronic address: jmp2003@med.cornell.edu.

Abstract

The prognostic performance of coronary artery calcium score (CACS) for predicting adverse outcomes in patients with decreased renal function remains unclear. We aimed to examine whether CACS improves risk stratification by demonstrating incremental value beyond a traditional risk score according to renal function status. 9,563 individuals without known coronary artery disease were enrolled. Estimated glomerular filtration rate (eGFR, ml/min/1.73 m2) was ascertained using the modified Modification of Diet in Renal Disease formula, and was categorized as: ≥90, 60 to 89, and <60. CACS was categorized as 0, 1 to 100, 101 to 400, and >400. Multivariable Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (95% CI) for major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, and late revascularization (>90 days). Mean age was 55.8 ± 11.5 years (52.8% male). In total, 261 (2.7%) patients experienced MACE over a median follow-up of 24.5 months (interquartile range: 16.9 to 41.1). Incident MACE increased with higher CACS across each eGFR category, with the highest rate observed among patients with CACS >400 and eGFR <60 (95.1 per 1,000 person-years). A CACS >400 increased MACE risk with HR 4.46 (95% CI 1.68 to 11.85), 6.63 (95% CI 4.03 to 10.92), and 6.14 (95% CI 2.85 to 13.21) for eGFR ≥90, 60 to 89, and <60, respectively, as compared with CACS 0. Further, CACS improved discrimination and reclassification beyond Framingham 10-year risk score (FRS) (AUC: 0.70 vs 0.64; category free-NRI: 0.51, all p <0.001) for predicting MACE in patients with impaired renal function (eGFR < 90). In conclusion, CACS improved risk stratification and provided incremental value beyond FRS for predicting MACE, irrespective of eGFR status.

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