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. 2021 Jun 1:148:16-21.
doi: 10.1016/j.amjcard.2021.02.038. Epub 2021 Mar 3.

Thoracic Aortic Calcium for the Prediction of Stroke Mortality (from the Coronary Artery Calcium Consortium)

Olufunmilayo H Obisesan  1 , Albert D Osei  2 , Daniel Berman  3 , Zeina A Dardari  1 , S M Iftekhar Uddin  1 , Omar Dzaye  1 , Olusola A Orimoloye  4 , Matthew J Budoff  5 , Michael D Miedema  6 , John Rumberger  7 , Mohammadhassan Mirbolouk  8 , Ellen Boakye  1 , Michelle C Johansen  1 , Alan Rozanski  9 , Leslee J Shaw  10 , Donghee Han  11 , Khurram Nasir  12 , Michael J Blaha  13
Affiliations

Thoracic Aortic Calcium for the Prediction of Stroke Mortality (from the Coronary Artery Calcium Consortium)

Olufunmilayo H Obisesan et al. Am J Cardiol. .

Abstract

Thoracic aortic calcium(TAC) is an important marker of extracoronary atherosclerosis with established predictive value for all-cause mortality. We sought to explore the predictive value of TAC for stroke mortality, independent of the more established coronary artery calcium (CAC) score. The CAC Consortium is a retrospectively assembled database of 66,636 patients aged ≥18 years with no previous history of cardiovascular disease, baseline CAC scans for risk stratification, and follow-up for 12 ± 4 years. CAC scans capture the adjacent thoracic aorta, enabling assessment of TAC from the same images. TAC was available in 41,066 (62%), and was primarily analyzed as present or not present. To account for competing risks for nonstroke death, we utilized multivariable-adjusted Fine and Gray competing risk regression models adjusted for traditional cardiovascular risk factors and CAC score. The mean age of participants was 53.8 ± 10.3 years, with 34.4% female. There were 110 stroke deaths during follow-up. The unadjusted subdistribution hazard ratio (SHR) for stroke mortality in those who had TAC present compared with those who did not was 8.80 (95% confidence interval [CI]: 5.97, 12.98). After adjusting for traditional risk factors and CAC score, the SHR was 2.21 (95% CI:1.39,3.49). In sex-stratified analyses, the fully adjusted SHR for females was 3.42 (95% CI: 1.74, 6.73) while for males it was 1.55 (95% CI: 0.83, 2.90). TAC was associated with stroke mortality independent of CAC and traditional risk factors, more so in women. The presence of TAC appears to be an independent risk marker for stroke mortality.

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Conflict of interest statement

Conflict of interest

The authors declare no conflict of interest relevant to the content of this manuscript.

Declaration of interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1:
Figure 1:
Cumulative incidence function curves for individuals with and without TAC
Figure 2:
Figure 2:
Cumulative incidence function curves for individuals with and without TAC by CAC category
See this image and copyright information in PMC

Comment in

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