A 15-year warranty period for asymptomatic individuals without coronary artery calcium: a prospective follow-up of 9715 individuals

Valentina Valenti; Bríain ó Hartaigh; Ran Heo; Iksung Cho; Joshua Schulman-Marcus; Heidi Gransar; Quynh A. Truong; Leslee J. Shaw; Joseph Knapper; Anita A. Kelkar; Pratik Sandesara; Fay Y. Lin; Sebastiano Sciarretta; Hyuk-Jae Chang; Tracy Q. Callister; James K Min

doi:10.1016/j.jcmg.2015.01.025

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A 15-year warranty period for asymptomatic individuals without coronary artery calcium: a prospective follow-up of 9715 individuals

Authors: Valentina Valenti ; Bríain ó Hartaigh ; Ran Heo ; Iksung Cho ; Joshua Schulman-Marcus ; Heidi Gransar ; Quynh A. Truong ; Leslee J. Shaw ; Joseph Knapper ; Anita A. Kelkar ; Pratik Sandesara ; Fay Y. Lin ; Sebastiano Sciarretta ; Hyuk-Jae Chang ; Tracy Q. Callister ; James K Min

Citation: JACC-CARDIOVASCULAR IMAGING, Vol.8(8) : 900-909, 2015

Journal Title: JACC-CARDIOVASCULAR IMAGING

ISSN: 1936-878X

Issue Date: 2015

MeSH: Aged ; Aged, 80 and over ; Area Under Curve ; Calcium/analysis* ; Cardiovascular Diseases/mortality* ; Coronary Vessels/chemistry* ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Prospective Studies ; ROC Curve ; Regression Analysis ; Risk Factors ; Time Factors ; Tomography, X-Ray Computed*

Keywords: Coronary artery calcium ; prognosis ; warranty period ; mortality ; computed tomography

Abstract: OBJECTIVES: The aim of this study was to examine the long-term prognosis in asymptomatic individuals with a coronary artery calcium (CAC) score of 0 and its associated warranty period.

BACKGROUND: Emerging evidence supports a CAC score of 0 as a favorable cardiovascular short-to intermediate-term prognostic factor.

METHODS: A total of 9,715 individuals undergoing CAC imaging were stratified by age, Framingham risk score (FRS), and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) categories and followed for a mean of 14.6 years (range 12.9 to 16.8 years). Cox regression, area under the receiver-operating characteristic curve, and net reclassification information were used to assess all-cause mortality, discrimination, and reclassification of a CAC score of 0 compared with the FRS and NCEP ATP III, respectively. A warranty period was pre-defined as <1% annual mortality rate. Vascular age was estimated by linear regression.

RESULTS: In 4,864 individuals with a baseline CAC score of 0 (mean age, 52.1 ± 10.8 years; 57.9% male), 229 deaths occurred. The warranty period of a CAC score of 0 was almost 15 years for individuals at low and intermediate risk with no significant differences regarding age and sex. A CAC score of 0 was associated with a vascular age of 1, 10, 20, and 30 years less than the chronological age of individuals between 50 and 59, 60 and 69, 70 and 79, and 80 years of age and older, respectively. The CAC score was the strongest predictor of death (hazard ratio: 2.67, 95% confidence interval: 2.29 to 3.11) that enabled discrimination and consistent reclassification beyond the FRS (area under the receiver-operating characteristic curve: 0.71 vs. 0.64, p < 0.001) and NCEP ATP III (area under the receiver-operating characteristic curve: 0.72 vs. 0.64, p < 0.001).

CONCLUSIONS: A CAC score of 0 confers a 15-year warranty period against mortality in individuals at low to intermediate risk that is unaffected by age or sex. Furthermore, in individuals considered at high risk by clinical risk scores, a CAC score of 0 confers better survival than in individuals at low to intermediate risk but with any CAC score.