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. 2024 Nov 25;13(23):7136.
doi: 10.3390/jcm13237136.

The Impact of the Coronary Artery Calcium Score on the Clinical Outcomes in Patients with Acute Myocardial Infarction

Hisashi Sato  1 , Kenichi Sakakura  1 , Hiroyuki Jinnouchi  1 , Yousuke Taniguchi  1 , Kei Yamamoto  1 , Takunori Tsukui  1 , Masashi Hatori  1 , Taku Kasahara  1 , Yusuke Watanabe  1 , Shun Ishibashi  1 , Masaru Seguchi  1 , Hideo Fujita  1
Affiliations

The Impact of the Coronary Artery Calcium Score on the Clinical Outcomes in Patients with Acute Myocardial Infarction

Hisashi Sato et al. J Clin Med. .

Abstract

Background: It is essential to identify the risk factors for poor clinical outcomes in patients with acute myocardial infarction (AMI). The coronary artery calcium score (CACS) is gathering attention as a predictor for future cardiovascular events. This study aimed to (1) measure CACSs in patients with AMI by non-ECG-gated computed tomography (CT), (2) compare clinical outcomes between patients with a high CACS and a low-intermediate CACS and (3) to elucidate the association between high CACS and clinical outcomes. Methods: We defined the high CACS group as the highest quantile of CACS (Q4) and defined the low-intermediate CACS group as the other quantiles of CACS (Q1-Q3). The primary endpoint was major adverse cardiovascular events (MACE), which were defined as the composite of all-cause death, re-admission for heart failure, non-fatal MI and target vessel revascularization. We included 548 patients with AMI who underwent non-ECG-gated CT and divided them into the high CACS group (CACS ≥ 5346.5, n = 137) and the low-intermediate CACS group (CACS ≤ 5329.3, n = 411). Results: During the median follow-up duration of 535 days, 150 MACE were observed. The Kaplan-Meier curves showed that MACE occurred more frequently in the high CACS group than in the low-intermediate CACS group (p < 0.001). Multivariable Cox hazard analysis revealed that a high CACS was significantly associated with MACE (hazard ratio 1.597, 95% confidence interval 1.081-2.358, p = 0.019) after controlling for multiple confounding factors. Conclusions: Clinical outcomes were worse in AMI patients with a high CACS than in those with a low-intermediate CACS. A high CACS was significantly associated with MACE in multivariate analysis.

Keywords: acute myocardial infarction; coronary artery calcium score; major adverse cardiovascular events.

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Conflict of interest statement

K. Sakakura received a speaking honorarium from Canon. The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The study flow chart. Abbreviations: AMI = acute myocardial infarction, CABG = coronary artery bypass surgery, CT = computed tomography, PCI = percutaneous coronary intervention, CACS = coronary artery calcium score.
Figure 2
Figure 2
Kaplan–Meier curves for major adverse cardiovascular event-free survival between high CACS and the low–intermediate CACS groups. A log–rank test was used. Abbreviations: MACE = major adverse cardiovascular events, CACS = coronary artery calcium score.
Figure 3
Figure 3
(A) Kaplan–Meier curves for all-cause death-free survival between the high CACS and low–intermediate CACS groups. (B) Kaplan–Meier curves for re-admission for heart failure-free survival between the high CACS and low–intermediate CACS groups. (C) Kaplan–Meier curves for non-fatal MI-free survival between the high CACS and low–intermediate CACS groups (D) Kaplan–Meier curves for target vessel revascularization-free survival between the high CACS and low–intermediate CACS groups. A log–rank test was used. Abbreviations: CACS = coronary artery calcium score.
Figure 3
Figure 3
(A) Kaplan–Meier curves for all-cause death-free survival between the high CACS and low–intermediate CACS groups. (B) Kaplan–Meier curves for re-admission for heart failure-free survival between the high CACS and low–intermediate CACS groups. (C) Kaplan–Meier curves for non-fatal MI-free survival between the high CACS and low–intermediate CACS groups (D) Kaplan–Meier curves for target vessel revascularization-free survival between the high CACS and low–intermediate CACS groups. A log–rank test was used. Abbreviations: CACS = coronary artery calcium score.
Figure 3
Figure 3
(A) Kaplan–Meier curves for all-cause death-free survival between the high CACS and low–intermediate CACS groups. (B) Kaplan–Meier curves for re-admission for heart failure-free survival between the high CACS and low–intermediate CACS groups. (C) Kaplan–Meier curves for non-fatal MI-free survival between the high CACS and low–intermediate CACS groups (D) Kaplan–Meier curves for target vessel revascularization-free survival between the high CACS and low–intermediate CACS groups. A log–rank test was used. Abbreviations: CACS = coronary artery calcium score.
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