The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry)

Ji Hyun Lee; Asim Rizvi; Bríain Ó. Hartaigh; Donghee Han; Mahn Won Park; Hadi Mirhedayati Roudsari; Wijnand J. Stuijfzand; Heidi Gransar; Yao Lu; Tracy Q. Callister; Daniel S. Berman; Augustin DeLago; Martin Hadamitzky; Joerg Hausleiter; Mouaz H. Al-Mallah; Matthew J. Budoff; Philipp A. Kaufmann; Gilbert L. Raff; Kavitha Chinnaiyan; Filippo Cademartiri; Erica Maffei; Todd C. Villines; Yong-Jin Kim; Jonathon Leipsic; Gudrun Feuchtner; Gianluca Pontone; Daniele Andreini; Hugo Marques; Pedro de Araújo Gonçalves; Ronen Rubinshtein; Stephan Achenbach; Leslee J. Shaw; Benjamin J. W. Chow; Ricardo C. Cury; Jeroen J. Bax; Hyuk-Jae Chang; Erica C. Jones; Fay Y. Lin; James K. Min; Jessica M. Peña

doi:10.1016/j.amjcard.2019.01.055

The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry)

Ji Hyun Lee
, Asim Rizvi
, Bríain Ó. Hartaigh
, Donghee Han
, Mahn Won Park
, Hadi Mirhedayati Roudsari
, Wijnand J. Stuijfzand
, Heidi Gransar
, Yao Lu
, Tracy Q. Callister
, Daniel S. Berman
, Augustin DeLago
, Martin Hadamitzky
, Joerg Hausleiter
, Mouaz H. Al-Mallah
, Matthew J. Budoff
, Philipp A. Kaufmann
, Gilbert L. Raff
, Kavitha Chinnaiyan
, Filippo Cademartiri

Erica Maffei, Todd C. Villines, Yong-Jin Kim, Jonathon Leipsic, Gudrun Feuchtner, Gianluca Pontone, Daniele Andreini, Hugo Marques, Pedro de Araújo Gonçalves, Ronen Rubinshtein, Stephan Achenbach, Leslee J. Shaw, Benjamin J. W. Chow, Ricardo C. Cury, Jeroen J. Bax, Hyuk-Jae Chang, Erica C. Jones, Fay Y. Lin, James K. Min, Jessica M. Peña

Dalio Institute of Cardiovascular Imaging, New York, United States
Department of Cardiology, Goyang-si, South Korea
Division of Cardiology, Seoul, South Korea
Department of Radiology, Rochester, United States
Department of Imaging, Los Angeles, United States
Department of Healthcare Policy and Research, New York, United States
Tennessee Heart and Vascular Institute, Hendersonville, United States
Department of Imaging and Medicine, Los Angeles, United States
Capitol Cardiology Associates, Albany, United States
Department of Radiology and Nuclear Medicine, Munich, Germany
Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany
Houston Methodist DeBakey Heart & Vascular Center, Houston, United States
Department of Medicine, Torrance, United States
Department of Nuclear Medicine, Zurich, Switzerland
Department of Cardiology, Royal Oak, United States
Cardiovascular Imaging Center, Naples, Italy
Department of Radiology, Urbino, Italy
Department of Cardiology, Bethesda, United States
Seoul National University Hospital, Seoul, South Korea
Department of Medicine and Radiology, Vancouver, Canada
Department of Radiology, Innsbruck, Austria
Centro Cardiologico Monzino, Milan, Italy
UNICA, Lisboa, Portugal
Department of Cardiology at the Lady Davis Carmel Medical Center, Haifa, Israel
Department of Cardiology, Erlangen, Germany
Department of Medicine and Radiology, Ottawa, Canada
Department of Radiology, Miami, United States
Department of Cardiology, Leiden, Netherlands

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

The prognostic performance of coronary artery calcium score (CACS) for predicting adverse outcomes in patients with decreased renal function remains unclear. We aimed to examine whether CACS improves risk stratification by demonstrating incremental value beyond a traditional risk score according to renal function status. 9,563 individuals without known coronary artery disease were enrolled. Estimated glomerular filtration rate (eGFR, ml/min/1.73 m 2 ) was ascertained using the modified Modification of Diet in Renal Disease formula, and was categorized as: ≥90, 60 to 89, and <60. CACS was categorized as 0, 1 to 100, 101 to 400, and >400. Multivariable Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (95% CI) for major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, and late revascularization (>90 days). Mean age was 55.8 ± 11.5 years (52.8% male). In total, 261 (2.7%) patients experienced MACE over a median follow-up of 24.5 months (interquartile range: 16.9 to 41.1). Incident MACE increased with higher CACS across each eGFR category, with the highest rate observed among patients with CACS >400 and eGFR <60 (95.1 per 1,000 person-years). A CACS >400 increased MACE risk with HR 4.46 (95% CI 1.68 to 11.85), 6.63 (95% CI 4.03 to 10.92), and 6.14 (95% CI 2.85 to 13.21) for eGFR ≥90, 60 to 89, and <60, respectively, as compared with CACS 0. Further, CACS improved discrimination and reclassification beyond Framingham 10-year risk score (FRS) (AUC: 0.70 vs 0.64; category free-NRI: 0.51, all p <0.001) for predicting MACE in patients with impaired renal function (eGFR < 90). In conclusion, CACS improved risk stratification and provided incremental value beyond FRS for predicting MACE, irrespective of eGFR status.

Original language	English
Pages (from-to)	1435-1442
Journal	American journal of cardiology
Volume	123
Issue number	9
DOIs	https://doi.org/10.1016/j.amjcard.2019.01.055
Publication status	Published - 1 May 2019
Externally published	Yes

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Lee, J. H., Rizvi, A., Hartaigh, B. Ó., Han, D., Park, M. W., Roudsari, H. M., Stuijfzand, W. J., Gransar, H., Lu, Y., Callister, T. Q., Berman, D. S., DeLago, A., Hadamitzky, M., Hausleiter, J., Al-Mallah, M. H., Budoff, M. J., Kaufmann, P. A., Raff, G. L., Chinnaiyan, K., ... Peña, J. M. (2019). The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry). American journal of cardiology, 123(9), 1435-1442. https://doi.org/10.1016/j.amjcard.2019.01.055

Lee, Ji Hyun ; Rizvi, Asim ; Hartaigh, Bríain Ó. et al. / The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry). In: American journal of cardiology. 2019 ; Vol. 123, No. 9. pp. 1435-1442.

@article{8cacf492dd834fffaed1188e102a05c8,

title = "The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry)",

abstract = "The prognostic performance of coronary artery calcium score (CACS) for predicting adverse outcomes in patients with decreased renal function remains unclear. We aimed to examine whether CACS improves risk stratification by demonstrating incremental value beyond a traditional risk score according to renal function status. 9,563 individuals without known coronary artery disease were enrolled. Estimated glomerular filtration rate (eGFR, ml/min/1.73 m 2 ) was ascertained using the modified Modification of Diet in Renal Disease formula, and was categorized as: ≥90, 60 to 89, and <60. CACS was categorized as 0, 1 to 100, 101 to 400, and >400. Multivariable Cox regression was used to estimate hazard ratios (HR) with 95\% confidence intervals (95\% CI) for major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, and late revascularization (>90 days). Mean age was 55.8 ± 11.5 years (52.8\% male). In total, 261 (2.7\%) patients experienced MACE over a median follow-up of 24.5 months (interquartile range: 16.9 to 41.1). Incident MACE increased with higher CACS across each eGFR category, with the highest rate observed among patients with CACS >400 and eGFR <60 (95.1 per 1,000 person-years). A CACS >400 increased MACE risk with HR 4.46 (95\% CI 1.68 to 11.85), 6.63 (95\% CI 4.03 to 10.92), and 6.14 (95\% CI 2.85 to 13.21) for eGFR ≥90, 60 to 89, and <60, respectively, as compared with CACS 0. Further, CACS improved discrimination and reclassification beyond Framingham 10-year risk score (FRS) (AUC: 0.70 vs 0.64; category free-NRI: 0.51, all p <0.001) for predicting MACE in patients with impaired renal function (eGFR < 90). In conclusion, CACS improved risk stratification and provided incremental value beyond FRS for predicting MACE, irrespective of eGFR status.",

author = "Lee, \{Ji Hyun\} and Asim Rizvi and Hartaigh, \{Br{\'i}ain {\'O}.\} and Donghee Han and Park, \{Mahn Won\} and Roudsari, \{Hadi Mirhedayati\} and Stuijfzand, \{Wijnand J.\} and Heidi Gransar and Yao Lu and Callister, \{Tracy Q.\} and Berman, \{Daniel S.\} and Augustin DeLago and Martin Hadamitzky and Joerg Hausleiter and Al-Mallah, \{Mouaz H.\} and Budoff, \{Matthew J.\} and Kaufmann, \{Philipp A.\} and Raff, \{Gilbert L.\} and Kavitha Chinnaiyan and Filippo Cademartiri and Erica Maffei and Villines, \{Todd C.\} and Yong-Jin Kim and Jonathon Leipsic and Gudrun Feuchtner and Gianluca Pontone and Daniele Andreini and Hugo Marques and \{de Ara{\'u}jo Gon{\c c}alves\}, Pedro and Ronen Rubinshtein and Stephan Achenbach and Shaw, \{Leslee J.\} and Chow, \{Benjamin J. W.\} and Cury, \{Ricardo C.\} and Bax, \{Jeroen J.\} and Hyuk-Jae Chang and Jones, \{Erica C.\} and Lin, \{Fay Y.\} and Min, \{James K.\} and Pe{\~n}a, \{Jessica M.\}",

year = "2019",

month = may,

day = "1",

doi = "10.1016/j.amjcard.2019.01.055",

language = "English",

volume = "123",

pages = "1435--1442",

journal = "American journal of cardiology",

issn = "0002-9149",

publisher = "Elsevier Inc.",

number = "9",

}

Lee, JH, Rizvi, A, Hartaigh, BÓ, Han, D, Park, MW, Roudsari, HM, Stuijfzand, WJ, Gransar, H, Lu, Y, Callister, TQ, Berman, DS, DeLago, A, Hadamitzky, M, Hausleiter, J, Al-Mallah, MH, Budoff, MJ, Kaufmann, PA, Raff, GL, Chinnaiyan, K, Cademartiri, F, Maffei, E, Villines, TC, Kim, Y-J, Leipsic, J, Feuchtner, G, Pontone, G, Andreini, D, Marques, H, de Araújo Gonçalves, P, Rubinshtein, R, Achenbach, S, Shaw, LJ, Chow, BJW, Cury, RC, Bax, JJ, Chang, H-J, Jones, EC, Lin, FY, Min, JK & Peña, JM 2019, 'The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry)', American journal of cardiology, vol. 123, no. 9, pp. 1435-1442. https://doi.org/10.1016/j.amjcard.2019.01.055

The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry). / Lee, Ji Hyun; Rizvi, Asim; Hartaigh, Bríain Ó. et al.
In: American journal of cardiology, Vol. 123, No. 9, 01.05.2019, p. 1435-1442.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry)

AU - Lee, Ji Hyun

AU - Rizvi, Asim

AU - Hartaigh, Bríain Ó.

AU - Han, Donghee

AU - Park, Mahn Won

AU - Roudsari, Hadi Mirhedayati

AU - Stuijfzand, Wijnand J.

AU - Gransar, Heidi

AU - Lu, Yao

AU - Callister, Tracy Q.

AU - Berman, Daniel S.

AU - DeLago, Augustin

AU - Hadamitzky, Martin

AU - Hausleiter, Joerg

AU - Al-Mallah, Mouaz H.

AU - Budoff, Matthew J.

AU - Kaufmann, Philipp A.

AU - Raff, Gilbert L.

AU - Chinnaiyan, Kavitha

AU - Cademartiri, Filippo

AU - Maffei, Erica

AU - Villines, Todd C.

AU - Kim, Yong-Jin

AU - Leipsic, Jonathon

AU - Feuchtner, Gudrun

AU - Pontone, Gianluca

AU - Andreini, Daniele

AU - Marques, Hugo

AU - de Araújo Gonçalves, Pedro

AU - Rubinshtein, Ronen

AU - Achenbach, Stephan

AU - Shaw, Leslee J.

AU - Chow, Benjamin J. W.

AU - Cury, Ricardo C.

AU - Bax, Jeroen J.

AU - Chang, Hyuk-Jae

AU - Jones, Erica C.

AU - Lin, Fay Y.

AU - Min, James K.

AU - Peña, Jessica M.

PY - 2019/5/1

Y1 - 2019/5/1

N2 - The prognostic performance of coronary artery calcium score (CACS) for predicting adverse outcomes in patients with decreased renal function remains unclear. We aimed to examine whether CACS improves risk stratification by demonstrating incremental value beyond a traditional risk score according to renal function status. 9,563 individuals without known coronary artery disease were enrolled. Estimated glomerular filtration rate (eGFR, ml/min/1.73 m 2 ) was ascertained using the modified Modification of Diet in Renal Disease formula, and was categorized as: ≥90, 60 to 89, and <60. CACS was categorized as 0, 1 to 100, 101 to 400, and >400. Multivariable Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (95% CI) for major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, and late revascularization (>90 days). Mean age was 55.8 ± 11.5 years (52.8% male). In total, 261 (2.7%) patients experienced MACE over a median follow-up of 24.5 months (interquartile range: 16.9 to 41.1). Incident MACE increased with higher CACS across each eGFR category, with the highest rate observed among patients with CACS >400 and eGFR <60 (95.1 per 1,000 person-years). A CACS >400 increased MACE risk with HR 4.46 (95% CI 1.68 to 11.85), 6.63 (95% CI 4.03 to 10.92), and 6.14 (95% CI 2.85 to 13.21) for eGFR ≥90, 60 to 89, and <60, respectively, as compared with CACS 0. Further, CACS improved discrimination and reclassification beyond Framingham 10-year risk score (FRS) (AUC: 0.70 vs 0.64; category free-NRI: 0.51, all p <0.001) for predicting MACE in patients with impaired renal function (eGFR < 90). In conclusion, CACS improved risk stratification and provided incremental value beyond FRS for predicting MACE, irrespective of eGFR status.

AB - The prognostic performance of coronary artery calcium score (CACS) for predicting adverse outcomes in patients with decreased renal function remains unclear. We aimed to examine whether CACS improves risk stratification by demonstrating incremental value beyond a traditional risk score according to renal function status. 9,563 individuals without known coronary artery disease were enrolled. Estimated glomerular filtration rate (eGFR, ml/min/1.73 m 2 ) was ascertained using the modified Modification of Diet in Renal Disease formula, and was categorized as: ≥90, 60 to 89, and <60. CACS was categorized as 0, 1 to 100, 101 to 400, and >400. Multivariable Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (95% CI) for major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, and late revascularization (>90 days). Mean age was 55.8 ± 11.5 years (52.8% male). In total, 261 (2.7%) patients experienced MACE over a median follow-up of 24.5 months (interquartile range: 16.9 to 41.1). Incident MACE increased with higher CACS across each eGFR category, with the highest rate observed among patients with CACS >400 and eGFR <60 (95.1 per 1,000 person-years). A CACS >400 increased MACE risk with HR 4.46 (95% CI 1.68 to 11.85), 6.63 (95% CI 4.03 to 10.92), and 6.14 (95% CI 2.85 to 13.21) for eGFR ≥90, 60 to 89, and <60, respectively, as compared with CACS 0. Further, CACS improved discrimination and reclassification beyond Framingham 10-year risk score (FRS) (AUC: 0.70 vs 0.64; category free-NRI: 0.51, all p <0.001) for predicting MACE in patients with impaired renal function (eGFR < 90). In conclusion, CACS improved risk stratification and provided incremental value beyond FRS for predicting MACE, irrespective of eGFR status.

UR - https://www.scopus.com/pages/publications/85062357187

UR - https://www.ncbi.nlm.nih.gov/pubmed/30850210

U2 - 10.1016/j.amjcard.2019.01.055

DO - 10.1016/j.amjcard.2019.01.055

M3 - Article

C2 - 30850210

SN - 0002-9149

VL - 123

SP - 1435

EP - 1442

JO - American journal of cardiology

JF - American journal of cardiology

IS - 9

ER -

Lee JH, Rizvi A, Hartaigh BÓ, Han D, Park MW, Roudsari HM et al. The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry). American journal of cardiology. 2019 May 1;123(9):1435-1442. doi: 10.1016/j.amjcard.2019.01.055

The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry)

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