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Comparative Study
. 2013 May-Jun;7(3):182-91.
doi: 10.1016/j.jcct.2013.05.009. Epub 2013 Jun 13.

A comparison of outcomes with coronary artery calcium scanning in unselected populations: the Multi-Ethnic Study of Atherosclerosis (MESA) and Heinz Nixdorf RECALL study (HNR)

Matthew J Budoff  1 , Stefan Möhlenkamp, Robyn McClelland, Joseph A Delaney, Marcus Bauer, Heinz Karl Jöckel, Hagen Kälsch, Richard Kronmal, Khurram Nasir, Nils Lehmann, Susanne Moebus, Ken Mukamal, Raimund Erbel; Multi-Ethnic Study of Atherosclerosis and the Investigator Group of the Heinz Nixdorf RECALL Study
Affiliations
Comparative Study

A comparison of outcomes with coronary artery calcium scanning in unselected populations: the Multi-Ethnic Study of Atherosclerosis (MESA) and Heinz Nixdorf RECALL study (HNR)

Matthew J Budoff et al. J Cardiovasc Comput Tomogr. 2013 May-Jun.

Abstract

Background: The Multi-Ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf RECALL (Risk factors, Evaluation of Coronary Calcium and Lifestyle Factors) study (HNR) differed in regard to informing physicians and patients of the results of their subclinical atherosclerosis.

Objective: This study investigates whether the association of the presence of coronary calcium with incident nonfatal and fatal cardiovascular events is different among these 2 large, population-based observational studies.

Methods: All white subjects aged 45 to 75 years, free of baseline cardiovascular disease were included (n = 2232 in MESA; n = 3119 HNR participants). We studied the association between coronary calcium and event rates at 5 years, including hard cardiac events (myocardial infarction, cardiac death, resuscitated cardiac arrest), and separately added revascularizations and strokes (fatal and nonfatal) to determine adjusted hazard ratios.

Results: Both cohorts showed low coronary heart disease (including revascularization) rates with zero coronary calcium (1.13% and 1.16% over 5 years in MESA and HNR, respectively) and increasing significantly in both groups with Agatston score 100 to 399 (6.71% and 4.52% in MESA and HNR, respectively) and Agatston score > 400 (12.5% and 13.54% in MESA and HNR, respectively) and showing strong independent predictive values for Agatston scores of 100 to 399 and >400, despite multivariable adjustment for risk factors. Risk factor-adjusted 5-year revascularization rates were nearly identical for HNR and MESA and were generally low for both studies (1.4% [45 of 3119] for HNR and 1.9% [43 of 2232] for MESA) over 5 years.

Conclusions: Across 2 culturally diverse populations, Agatston score >400 is a strong predictor of events. High Agatston score did not statistically result in revascularization, and knowledge of the presence of coronary calcium did not increase revascularizations.

Keywords: Coronary artery calcification; Heinz Nixdorf RECALL study; Multi-Ethnic Study of Atherosclerosis; Subclinical atherosclerosis.

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Figures

Figure 1
Figure 1
Multi-Ethnic Study of Atherosclerosis (MESA) decision tree for inclusion in joint study
Figure 2
Figure 2
Heinz Nixdorf Recall Study (HNR).decision tree for inclusion in joint study * myocardial infarction, previous heart surgery, bypass surgery, angioplasty, valve replacement, pacemaker, atrial fibrillation, heart failure, angina or stroke
See this image and copyright information in PMC

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