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Comparative Study
. 2017 Feb 14;6(2):e005179.
doi: 10.1161/JAHA.116.005179.

Comparison of Carotid Plaque Score and Coronary Artery Calcium Score for Predicting Cardiovascular Disease Events: The Multi-Ethnic Study of Atherosclerosis

Adam D Gepner  1 , Rebekah Young  2 , Joseph A Delaney  2 , Matthew J Budoff  3 , Joseph F Polak  4 , Michael J Blaha  5 , Wendy S Post  5 , Erin D Michos  5 , Joel Kaufman  2 , James H Stein  6
Affiliations
Comparative Study

Comparison of Carotid Plaque Score and Coronary Artery Calcium Score for Predicting Cardiovascular Disease Events: The Multi-Ethnic Study of Atherosclerosis

Adam D Gepner et al. J Am Heart Assoc. .

Abstract

Background: Coronary artery calcium (CAC) predicts coronary heart disease (CHD) events better than carotid wall plaque presence; however, differences in the utility of CAC burden and carotid plaque burden across the spectrum of cardiovascular disease (CVD) events is unknown.

Methods and results: CVD, CHD and stroke/transient ischemic attack (TIA) events were evaluated prospectively in a multiethnic cohort without CVD at baseline. Carotid plaque score was determined by the number of ultrasound-detected plaques in the common, bifurcation, and internal carotid artery segments. CAC was detected by computed tomography. Predictive values were compared using Cox proportional hazards models, C-statistics, and net reclassification, adjusting for traditional CVD risk factors. At baseline, the 4955 participants were mean (SD) 61.6 (10.1) years old and 52.8% female; 48.9% had CAC >0 and 50.8% had at least 1 carotid plaque. After 11.3 (3.0) years of follow-up, 709 CVD, 498 CHD, and 262 stroke/TIA events occurred. CAC score compared to carotid plaque score was a stronger predictor of CVD (hazard ratio [HR], 1.78; 95% CI, 1.16-1.98; P<0.001 vs HR, 1.27; 95% CI, 1.16-1.40; P<0.001) and CHD events (HR, 2.09; 95% CI, 1.84-2.38; P<0.001 vs HR, 1.35; 95% CI, 1.21-1.51; P<0.001). CAC score and carotid plaque score were weak predictors of stroke/TIA. CAC score had better reclassification statistics than carotid plaque score, except for stroke/TIA, which had similar predictive values.

Conclusions: CAC score improved prediction, discrimination, and reclassification of CVD and CHD better than carotid ultrasound measures, although prediction and discrimination were similar for stroke/TIA.

Keywords: atherosclerosis; cardiovascular disease; carotid artery; imaging; risk factor.

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Figures

Figure 1
Figure 1
Unadjusted Kaplan–Meier event curves for (A) CVD, (B) CHD, (C) stroke, and (D) stroke/TIA according to coronary artery calcium score. N=4955. *P<0.05, comparing each category to the next smallest category (eg, for stroke, the difference between 0 and 1 to 99 was significant at the 0.05 level). CAC indicates coronary artery calcium; CHD, coronary heart disease; CVD, cardiovascular disease; TIA, transient ischemic attack.
Figure 2
Figure 2
Unadjusted Kaplan–Meier event curves for (A) CVD, (B) CHD, (C) stroke, and (D) stroke/TIA according to carotid plaque score. N=4955. *P<0.05, comparing each category to the next smallest category (eg, for stroke, the difference between 1 and 2 to 6 was significant at the 0.05 level). CHD indicates coronary heart disease; CVD, cardiovascular disease; TIA, transient ischemic attack.
See this image and copyright information in PMC

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