Value of Progression of Coronary Artery Calcification for Risk Prediction of Coronary and Cardiovascular Events: Result of the HNR Study (Heinz Nixdorf Recall)
| Autor: | Nils Lehmann, Raimund Erbel, Amir A. Mahabadi, Michael Rauwolf, Stefan Möhlenkamp, Susanne Moebus, Hagen Kälsch, Thomas Budde, Axel Schmermund, Andreas Stang, Dagmar Führer-Sakel, Christian Weimar, Ulla Roggenbuck, Nico Dragano, Karl-Heinz Jöckel, T. Meinertz, C. Bode, P.J. de Feyter, B. Güntert, F. Gutzwiller, H. Heinen, O. Hess, B. Klein, H. Löwel, M. Reiser, G. Schmidt, M. Schwaiger, C. Steinmüller, T. Theorell, S.N. Willich, K. Berger, H.R. Figulla, C. Hamm, P. Hanrath, W. Köpcke, B. Ringelstein, M. Dichgans, A. Zeiher |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Population Medizin Computed tomography Coronary Artery Disease 030204 cardiovascular system & hematology Disease-Free Survival 03 medical and health sciences 0302 clinical medicine Risk Factors Physiology (medical) Internal medicine medicine Humans 030212 general & internal medicine education Vascular Calcification Aged education.field_of_study Recall medicine.diagnostic_test business.industry Disease progression Middle Aged Survival Rate Coronary artery calcium Coronary artery calcification Cohort Cardiology Female Cardiology and Cardiovascular Medicine Risk assessment business Tomography X-Ray Computed Algorithms Follow-Up Studies |
| Zdroj: | Circulation. 137(7) |
| ISSN: | 1524-4539 |
| Popis: | Background: Computed tomography (CT) allows estimation of coronary artery calcium (CAC) progression. We evaluated several progression algorithms in our unselected, population-based cohort for risk prediction of coronary and cardiovascular events. Methods: In 3281 participants (45–74 years of age), free from cardiovascular disease until the second visit, risk factors, and CTs at baseline (b) and after a mean of 5.1 years (5y) were measured. Hard coronary and cardiovascular events, and total cardiovascular events including revascularization, as well, were recorded during a follow-up time of 7.8±2.2 years after the second CT. The added predictive value of 10 CAC progression algorithms on top of risk factors including baseline CAC was evaluated by using survival analysis, C-statistics, net reclassification improvement, and integrated discrimination index. A subgroup analysis of risk in CAC categories was performed. Results: We observed 85 (2.6%) hard coronary, 161 (4.9%) hard cardiovascular, and 241 (7.3%) total cardiovascular events. Absolute CAC progression was higher with versus without subsequent coronary events (median, 115 [Q1–Q3, 23–360] versus 8 [0–83], P 5y and 5-year risk factors. An excellent prognosis was found for 921 participants with double-zero CAC b =CAC 5y =0 (10-year coronary and hard/total cardiovascular risk: 1.4%, 2.0%, and 2.8%), which was for participants with incident CAC 1.8%, 3.8%, and 6.6%, respectively. When CAC b progressed from 1 to 399 to CAC 5y ≥400, coronary and total cardiovascular risk were nearly 2-fold in comparison with subjects who remained below CAC 5y =400. Participants with CAC b ≥400 had high rates of hard coronary and hard/total cardiovascular events (10-year risk: 12.0%, 13.5%, and 30.9%, respectively). Conclusions: CAC progression is associated with coronary and cardiovascular event rates, but adds only weakly to risk prediction. What counts is the most recent CAC value and risk factor assessment. Therefore, a repeat scan >5 years after the first scan may be of additional value, except when a double-zero CT scan is present or when the subjects are already at high risk. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|