Coronary calcification measures predict mortality in symptomatic women and men

• Published in: Open heart Vol. 9; no. 2; p. e002005
• Main Authors: Siegersma, Klaske R, Groepenhoff, Floor, Eikendal, Anouk L M, Op den Brouw, Willemijn J, Leiner, Tim, Appelman, Yolande, Tulevski, Igor I, Somsen, G Aernout, Onland-Moret, N Charlotte, Hofstra, Leonard, den Ruijter, Hester M
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.12.2022; BMJ Publishing Group
• Series: Original research
• Subjects: Age; Asymptomatic; Atherosclerosis; Calcification; Cardiology; Cardiovascular disease; Coronary Artery Disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - epidemiology; Coronary vessels; Electronic health records; Ethnicity; Female; Gender differences; Humans; Male; Medical imaging; Medical prognosis; Mortality; Patients; Prognosis; Sexes; Statistics; Tomography, X-Ray Computed; Vascular Calcification - diagnostic imaging; Vascular Calcification - epidemiology; White people; Womens health; Netherlands; Europe; Coronary Stenosis; CORONARY ARTERY DISEASE; Electronic Health Records; Computed Tomography Angiography
• ISSN: 2053-3624; 2398-595X; 2053-3624
• DOI: 10.1136/openhrt-2022-002005

To assess the prognostic value of absolute and sex-specific, age-specific and race/ethnicity-specific (Multi-Ethnic Study of Atherosclerosis, MESA) percentiles of coronary artery calcification in symptomatic women and men. The study population consisted of 4985 symptomatic patients (2793 women, 56%) visiting a diagnostic outpatient cardiology clinic between 2009 and 2018 who were referred for cardiac CT to determine Coronary Artery Calcium Score (CACS). Regular care data were used and these data were linked to the databases of Statistics Netherlands for all-cause mortality data. Kaplan-Meier curves, multivariate Cox proportional hazards regression and concordance statistics were used to evaluate the prognostic value of CACS and MESA percentiles. Women were older compared with men (60 vs 59 years). Median CACS was 0 (IQR: 0-54) in women and 42 (IQR: 0-54) in men. After a median follow-up of 4.4 years (IQR: 3.1-6.3), 116 (2.3%; 53 women and 63 men) patients died. MESA percentiles did not perform better compared with absolute CACS (C-statistic 0.65, 95% CI 0.57 to 0.73, vs 0.66, 95% CI 0.58 to 0.74, in women and 0.59, 95% CI 0.51 to 0.67, vs 0.62, 95% CI 0.55 to 0.69, in men, for the percentiles and absolute CACS, respectively). In symptomatic individuals absolute CACS predicts mortality with a moderately good performance. MESA percentiles did not perform better compared with absolute CACS, thus there is no need to use them. Including degree of stenosis in the model might slightly improve mortality risk prediction in women, but not in men.