TY - JOUR
T1 - 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)
AU - Lee, Ji Hyun
AU - Rizvi, Asim
AU - Hartaigh, Bríain
AU - Han, Donghee
AU - Park, Mahn Won
AU - Roudsari, Hadi Mirhedayati
AU - Stuijfzand, Wijnand J.
AU - Gransar, Heidi
AU - Lu, Yao
AU - Callister, Tracy Q.
AU - Berman, Daniel S.
AU - DeLago, Augustin
AU - Hadamitzky, Martin
AU - Hausleiter, Joerg
AU - Al-Mallah, Mouaz H.
AU - Budoff, Matthew J.
AU - Kaufmann, Philipp A.
AU - Raff, Gilbert L.
AU - Chinnaiyan, Kavitha
AU - Cademartiri, Filippo
AU - Maffei, Erica
AU - Villines, Todd C.
AU - Kim, Yong Jin
AU - Leipsic, Jonathon
AU - Feuchtner, Gudrun
AU - Pontone, Gianluca
AU - Andreini, Daniele
AU - Marques, Hugo
AU - de Araújo Gonçalves, Pedro
AU - Rubinshtein, Ronen
AU - Achenbach, Stephan
AU - Shaw, Leslee J.
AU - Chow, Benjamin J.W.
AU - Cury, Ricardo C.
AU - Bax, Jeroen J.
AU - Chang, Hyuk Jae
AU - Jones, Erica C.
AU - Lin, Fay Y.
AU - Min, James K.
AU - Peña, Jessica M.
N1 - Publisher Copyright:
© 2019
PY - 2019/5/1
Y1 - 2019/5/1
N2 - 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 m 2 ) 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.
AB - 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 m 2 ) 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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U2 - 10.1016/j.amjcard.2019.01.055
DO - 10.1016/j.amjcard.2019.01.055
M3 - Article
C2 - 30850210
AN - SCOPUS:85062357187
SN - 0002-9149
VL - 123
SP - 1435
EP - 1442
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 9
ER -