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Multicenter Study
. 2020 Jan-Feb;14(1):12-17.
doi: 10.1016/j.jcct.2019.03.011. Epub 2019 Mar 28.

Validation of the Coronary Artery Calcium Data and Reporting System (CAC-DRS): Dual importance of CAC score and CAC distribution from the Coronary Artery Calcium (CAC) consortium

Omar Dzaye  1 , Ramzi Dudum  2 , Mohammadhassan Mirbolouk  3 , Olusola A Orimoloye  3 , Albert D Osei  3 , Zeina A Dardari  3 , Daniel S Berman  4 , Michael D Miedema  5 , Leslee Shaw  6 , Alan Rozanski  7 , Matthias Holdhoff  8 , Khurram Nasir  9 , John A Rumberger  10 , Matthew J Budoff  11 , Mouaz H Al-Mallah  12 , Ron Blankstein  13 , Michael J Blaha  14
Affiliations
Multicenter Study

Validation of the Coronary Artery Calcium Data and Reporting System (CAC-DRS): Dual importance of CAC score and CAC distribution from the Coronary Artery Calcium (CAC) consortium

Omar Dzaye et al. J Cardiovasc Comput Tomogr. 2020 Jan-Feb.

Abstract

Background: The Coronary Artery Calcium Data and Reporting System (CAC-DRS), which takes into account the Agatston score category (A) and the number of calcified vessels (N) has not yet been validated in terms of its prognostic significance.

Methods: We included 54,678 patients from the CAC Consortium, a large retrospective clinical cohort of asymptomatic individuals free of baseline cardiovascular disease (CVD). CAC-DRS groups were derived from routine, cardiac-gated CAC scans. Cox proportional hazards regression models, adjusted for traditional CVD risk factors, were used to assess the association between CAC-DRS groups and CHD, CVD, and all-cause mortality. CAC-DRS was then compared to CAC score groups and regional CAC distribution using area under the curve (AUC) analysis.

Results: The study population had a mean age of 54.2 ± 10.7, 34.4% female, and mean ASCVD score 7.3% ± 9.0. Over a mean follow-up of 12 ± 4 years, a total of 2,469 deaths (including 398 CHD deaths and 762 CVD deaths) were recorded. There was a graded risk for CHD, CVD and all-cause mortality with increasing CAC-DRS groups ranging from an all-cause mortality rate of 1.2 per 1,000 person-years for A0 to 15.4 per 1,000 person-years for A3/N4. In multivariable-adjusted models, those with CAC-DRS A3/N4 had significantly higher risk for CHD mortality (HR 5.9 (95% CI 3.6-9.9), CVD mortality (HR4.0 (95% CI 2.8-5.7), and all-cause mortality a (HR 2.5 (95% CI 2.1-3.0) compared to CAC-DRS A0. CAC-DRS had higher AUC than CAC score groups (0.762 vs 0.754, P < 0.001) and CAC distribution (0.762 vs 0.748, P < 0.001).

Conclusion: The CAC-DRS system, combining the Agatston score and the number of vessels with CAC provides better stratification of risk for CHD, CVD, and all-cause death than the Agatston score alone. These prognostic data strongly support new SCCT guidelines recommending the use CAC-DRS scoring.

Keywords: Computed tomography; Coronary artery calcium; Coronary artery calcium data and reporting system.

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Figures

Figure 1
Figure 1
Distribution of CAC-DRS scores
Figure 2.1
Figure 2.1
Cumulative incidence and incidence rates (per 1000 person-years) of CHD death
Figure 2.2
Figure 2.2
Cumulative incidence and incidence rates (per 1000 person-years) of CVD death
Figure 2.3
Figure 2.3
Cumulative incidence and incidence rates (per 1000 person-years) of All-cause death
See this image and copyright information in PMC

Comment in

References

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