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Observational Study
. 2017 Jan-Feb;11(1):54-61.
doi: 10.1016/j.jcct.2016.11.004. Epub 2016 Nov 11.

Rationale and design of the coronary artery calcium consortium: A multicenter cohort study

Michael J Blaha  1 , Seamus P Whelton  2 , Mahmoud Al Rifai  2 , Zeina A Dardari  2 , Leslee J Shaw  3 , Mouaz H Al-Mallah  4 , Kuni Matsushita  5 , John A Rumberger  6 , Daniel S Berman  7 , Matthew J Budoff  8 , Michael D Miedema  9 , Khurram Nasir  10
Affiliations
Observational Study

Rationale and design of the coronary artery calcium consortium: A multicenter cohort study

Michael J Blaha et al. J Cardiovasc Comput Tomogr. 2017 Jan-Feb.

Abstract

Background: Although coronary artery calcium (CAC) has been investigated for over two decades, there is very limited data on the association of CAC with cause of death. The CAC Consortium is a large ongoing multi-center observational cohort of individuals who underwent non-contrast cardiac-gated CAC testing and systematic, prospective, long-term follow-up for mortality with ascertainment of cause of death.

Methods: Four participating institutions from three states within the US (California, Minnesota, and Ohio) have contributed individual-level patient data to the CAC Consortium (spanning years 1991-2010). All CAC scans were clinically indicated and physician-referred in patients without a known history of coronary heart disease. Using strict inclusion and exclusion criteria to minimize missing data and to eliminate non-dedicated CAC scans (i.e. concomitant CT angiography), a sharply defined and well-characterized cohort of 66,636 patients was assembled. Mortality status was ascertained using the Social Security Administration Death Master File and a validated algorithm. In addition, death certificates were obtained from the National Death Index and categorized using ICD (International Classification of Diseases) codes into common causes of death.

Results: Mean patient age was 54 ± 11 years and the majority were male (67%). Prevalence of CVD risk factors was similar across sites and 55% had a <5% estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk. Approximately 45% had a Calcium score of 0 and 11% had an Agatston Score ≥400. Over a mean follow-up of 12 ± 4 years, there were 3158 deaths (4.15 per 1000 person-years). The majority of deaths were due to cancer (37%) and CVD (32%). Most CVD deaths were due to CHD (54%) followed by stroke (17%). In general, CAC score distributions were similar across sites, and there were similar cause of death patterns.

Conclusions: The CAC Consortium is large and highly generalizable data set that is uniquely positioned to expand the understanding of CAC as a predictor of mortality risk across the spectrum of disease states, allowing innovative modeling of the competing risks of cardiovascular and non-cardiovascular death.

Keywords: Coronary artery calcium.

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Figures

Figure 1
Figure 1
Study Design
Figure 2
Figure 2
Distribution of CAC Scores
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Figure 3
Age-Adjusted Mortality Rates By Study Site
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Figure 4
Causes of Death
Figure 5A
Figure 5A
Subtypes of CVD Death
Figure 5B
Figure 5B
Subtypes of Cancer Death
See this image and copyright information in PMC

References

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