Association of Coronary Artery Calcium Detected by Routine Ungated CT Imaging With Cardiovascular Outcomes.

Autor:	Peng AW; Department of Medicine, Stanford University, Stanford, California, USA; Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA. Electronic address: https://twitter.com/AllisonWPeng., Dudum R; Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA., Jain SS; Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA., Maron DJ; Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA; Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California, USA., Patel BN; Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA., Khandwala N; Bunkerhill Health, Palo Alto, California, USA., Eng D; Bunkerhill Health, Palo Alto, California, USA., Chaudhari AS; Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA; Department of Radiology, Stanford University, Stanford, California, USA; Department of Biomedical Data Science, Stanford University, Stanford, California, USA., Sandhu AT; Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA; Veteran's Affairs Palo Alto Healthcare System, Palo Alto, California, USA. Electronic address: https://twitter.com/ATSandhu., Rodriguez F; Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA. Electronic address: frodrigu@stanford.edu.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2023 Sep 19; Vol. 82 (12), pp. 1192-1202.
DOI:	10.1016/j.jacc.2023.06.040
Abstrakt:	Background: Coronary artery calcium (CAC) is a strong predictor of cardiovascular events across all racial and ethnic groups. CAC can be quantified on nonelectrocardiography (ECG)-gated computed tomography (CT) performed for other reasons, allowing for opportunistic screening for subclinical atherosclerosis. Objectives: The authors investigated whether incidental CAC quantified on routine non-ECG-gated CTs using a deep-learning (DL) algorithm provided cardiovascular risk stratification beyond traditional risk prediction methods. Methods: Incidental CAC was quantified using a DL algorithm (DL-CAC) on non-ECG-gated chest CTs performed for routine care in all settings at a large academic medical center from 2014 to 2019. We measured the association between DL-CAC (0, 1-99, or ≥100) with all-cause death (primary outcome), and the secondary composite outcomes of death/myocardial infarction (MI)/stroke and death/MI/stroke/revascularization using Cox regression. We adjusted for age, sex, race, ethnicity, comorbidities, systolic blood pressure, lipid levels, smoking status, and antihypertensive use. Ten-year atherosclerotic cardiovascular disease risk was calculated using the pooled cohort equations. Results: Of 5,678 adults without ASCVD (51% women, 18% Asian, 13% Hispanic/Latinx), 52% had DL-CAC >0. Those with DL-CAC ≥100 had an average 10-year ASCVD risk of 24%; yet, only 26% were on statins. After adjustment, patients with DL-CAC ≥100 had increased risk of death (HR: 1.51; 95% CI: 1.28-1.79), death/MI/stroke (HR: 1.57; 95% CI: 1.33-1.84), and death/MI/stroke/revascularization (HR: 1.69; 95% CI: 1.45-1.98) compared with DL-CAC = 0. Conclusions: Incidental CAC ≥100 was associated with an increased risk of all-cause death and adverse cardiovascular outcomes, beyond traditional risk factors. DL-CAC from routine non-ECG-gated CTs identifies patients at increased cardiovascular risk and holds promise as a tool for opportunistic screening to facilitate earlier intervention. Competing Interests: Funding Support and Author Disclosures This work was supported by the Stanford University Human-Centered Artificial Intelligence Seed Grant. Mr Khandwala and Mr Eng are employees and shareholders of Bunkerhill Health. Dr Chaudhari has received research support from the Stanford University Precision Health and Integrated Diagnostics Seed Grant and the Stanford University Human-Centered Artificial Intelligence–Artificial Intelligence in Medicine and Imaging Seed Grant; has provided consulting services to Subtle Medical, Chondrometrics GmbH, Image Analysis Group, Edge Analytics, ICM, and Culvert Engineering; is a shareholder of Subtle Medical, LVIS Corporation, and Brain Key; and receives research support from GE Healthcare and Philips, all outside of the submitted work. Dr Sandhu has received research support from the National Heart, Lung, and Blood Institute (1K23HL151672-01). Dr Rodriguez was funded by grants from the National Institutes of Health National Heart, Lung, and Blood Institute (1K01HL144607), the American Heart Association/Harold Amos Faculty Development program, and the Doris Duke Foundation (Grant #2022051); and has consulting relationships with Healthpals, Novartis, Novo Nordisk, Esperion, and AstraZeneca outside of the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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