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Multicenter Study
. 2015 Sep-Oct;9(5):406-14.
doi: 10.1016/j.jcct.2015.03.012. Epub 2015 Apr 7.

Multisite extracoronary calcification indicates increased risk of coronary heart disease and all-cause mortality: The Multi-Ethnic Study of Atherosclerosis

Geoffrey H Tison  1 , Mengye Guo  2 , Michael J Blaha  3 , Robyn L McClelland  2 , Matthew A Allison  4 , Moyses Szklo  5 , Nathan D Wong  6 , Roger S Blumenthal  3 , Matthew J Budoff  7 , Khurram Nasir  3
Affiliations
Multicenter Study

Multisite extracoronary calcification indicates increased risk of coronary heart disease and all-cause mortality: The Multi-Ethnic Study of Atherosclerosis

Geoffrey H Tison et al. J Cardiovasc Comput Tomogr. 2015 Sep-Oct.

Abstract

Background: Cardiovascular calcification outside of the coronary tree, known as extracoronary calcification (ECC), is highly prevalent, often occurs concurrently in multiple sites, and yet its prognostic value is unclear.

Objective: To determine whether multisite ECC is associated with coronary heart disease (CHD) events, CHD mortality, and all-cause mortality.

Methods: We evaluated 5903 participants from the Multi-Ethnic Study of Atherosclerosis without diabetes who underwent CT imaging for calcification of the aortic valve, aortic root, mitral valve, and thoracic aorta. Participants were followed for 10.3 years. Multivariable adjusted hazard ratios estimated risk of outcomes for increasing numbers of ECC sites (0, 1, 2, 3, and 4), and receiver operator characteristic analysis assessed model discrimination.

Results: Prevalence of any ECC was 45%; median age was 62 years. Compared with those without ECC, those with ECC in 4 sites had increased hazards of 4.5, 7.1 and 2.3 for CHD events, CHD mortality, and all-cause mortality, respectively, independent of traditional risk factors (TRF; all P ≤ .05), and had ≥2-fold increased hazards for outcomes independent of coronary artery calcification (CAC). Each additional site of ECC was positively associated with each outcome in a graded fashion. When added to TRF, ECC significantly increased the area under the receiver operator characteristic curve for all outcomes and modestly increased the area under the curve for mortality beyond TRF + CAC (0.799 to 0.802; P = .03).

Conclusion: Increasing multisite ECC has a graded association with higher CHD and mortality risk, contributing information beyond TRF. Multisite ECC incidentally identified on imaging can be used to improve individualized risk prediction.

Keywords: CHD events; Cardiovascular imaging; Extracoronary calcification; Mortality; Risk prediction.

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Figures

Figure 1
Figure 1
1a: Prevalence of ECC by CAC Score Categories in MESA 1b: Prevalence of ECC by Framingham 10-year CHD risk in MESA Unadjusted prevalence by CAC and Framingham risk strata
Figure 2
Figure 2. Unadjusted all-cause mortality rates per 1000 person years for ECC categories according to CAC score categories in MESA
Unadjusted mortality rates stratified by CAC and ECC
Figure 3
Figure 3
3a: Kaplan Meier Curves for incident CHD events by increasing number of ECC sites in the MESA cohort. 3b: Kaplan Meier Curves for CHD mortality by increasing number of ECC sites in the MESA cohort. 3c: Kaplan Meier Curves for all-cause mortality by increasing number of ECC sites in the MESA cohort Survival curves for incident CHD events, CHD mortality and all-cause mortality by increasing number of ECC sites
Figure 3
Figure 3
3a: Kaplan Meier Curves for incident CHD events by increasing number of ECC sites in the MESA cohort. 3b: Kaplan Meier Curves for CHD mortality by increasing number of ECC sites in the MESA cohort. 3c: Kaplan Meier Curves for all-cause mortality by increasing number of ECC sites in the MESA cohort Survival curves for incident CHD events, CHD mortality and all-cause mortality by increasing number of ECC sites
Figure 4
Figure 4. Example CT image from the MESA cohort showing extracoronary calcification
A-aortic valve calcification; C-coronary artery calcification; M-mitral annular calcification; T-thoracic aortic calcification
See this image and copyright information in PMC

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