Thoracic versus coronary calcification for atherosclerotic cardiovascular disease events prediction

• Published in: Heart (British Cardiac Society) Vol. 110; no. 14; pp. 947 - 953
• Main Authors: Ichikawa, Keishi, Wang, Rui, McClelland, Robyn L, Manubolu, Venkat S, Susarla, Shriraj, Lee, Duo, Pourafkari, Leili, Fazlalizadeh, Hooman, Bitar, Jairo Aldana, Robin, Rick, Kinninger, April, Roy, Sion, Post, Wendy S, Budoff, Matthew
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Cardiovascular Society 25.06.2024; BMJ Publishing Group LTD
• Subjects: Aged; Angina pectoris; Aorta, Thoracic - diagnostic imaging; Aortic Diseases - diagnosis; Aortic Diseases - diagnostic imaging; Aortic Diseases - epidemiology; Atherosclerosis; Atherosclerosis - diagnosis; Atherosclerosis - epidemiology; Blood pressure; Body mass index; Calcification; Cardiac risk factors and prevention; Cardiac-Gated Imaging Techniques; Cardiovascular disease; Cholesterol; Cohort analysis; Computed Tomography Angiography; Coronary Angiography - methods; Coronary Artery Disease; Coronary Artery Disease - diagnosis; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - epidemiology; Coronary vessels; Coronary Vessels - diagnostic imaging; Diabetes; Disease prevention; Education; Electrocardiography; Female; Humans; Incidence; Male; Medical imaging; Middle Aged; Predictive Value of Tests; Prognosis; Review boards; Risk Assessment - methods; Risk Factors; ROC Curve; Stroke; Tomography, X-Ray Computed; United States - epidemiology; Vascular Calcification - diagnostic imaging; Vascular Calcification - epidemiology; Veins & arteries; United States; New York; Los Angeles California; Minnesota; California; United States > US; Coronary Artery Disease; Computed Tomography Angiography; Atherosclerosis
• ISSN: 1355-6037; 1468-201X; 1468-201X
• DOI: 10.1136/heartjnl-2023-323838

This study compared the prognostic value of quantified thoracic artery calcium (TAC) including aortic arch on chest CT and coronary artery calcium (CAC) score on ECG-gated cardiac CT.MethodsA total of 2412 participants who underwent both chest CT and ECG-gated cardiac CT at the same period were included in the Multi-Ethnic Study of Atherosclerosis Exam 5. All participants were monitored for incident atherosclerotic cardiovascular disease (ASCVD) events. TAC is defined as calcification in the ascending aorta, aortic arch and descending aorta on chest CT. The quantification of TAC was measured using the Agatston method. Time-dependent receiver-operating characteristic (ROC) curves were used to compare the prognostic value of TAC and CAC scores.ResultsParticipants were 69±9 years of age and 47% were male. The Spearman correlation between TAC and CAC scores was 0.46 (p<0.001). During the median follow-up period of 8.8 years, 234 participants (9.7%) experienced ASCVD events. In multivariable Cox regression analysis, TAC score was independently associated with increased risk of ASCVD events (HR 1.31, 95% CI 1.09 to 1.58) as well as CAC score (HR 1.82, 95% CI 1.53 to 2.17). However, the area under the time-dependent ROC curve for CAC score was greater than that for TAC score in all participants (0.698 and 0.641, p=0.031). This was particularly pronounced in participants with borderline/intermediate and high 10-year ASCVD risk scores.ConclusionOur study demonstrated a significant association between TAC and CAC scores but a superior prognostic value of CAC score for ASCVD events. These findings suggest TAC on chest CT provides supplementary data to estimate ASCVD risk but does not replace CAC on ECG-gated cardiac CT.