Abstract MP053: Coronary Calcium on Standard Chest CT and Cardiovascular Disease Death in Community-Living Individuals
CAC on EBCT by the Agatston method predicts incident CVD events but is not covered by most insurances. Standard chest CT scans are done for many clinical indications. Shemesh et.al. recently proposed a simple CAC scoring system using standard chest CTs but correlations with Agatston CAC on EBCT and associations with CVD events in community-living populations is unknown.
Methods: 4,544 consecutive out-patients presented for elective CT scanning including EBCT for CAC and a standard chest CT for lung disease in 2000-03. Participants were followed through 2009; death certificates classified cause of death. In this nested case-control study, we identified cases of CVD death (n=56) and age/sex matched each with 3 controls. EBCT CAC was scored by Agatston method. Using the standard chest CTs, the 3 major coronary arteries and left main were scored from 0-3 (0, no calcium; 1, <1/3; 2, 1/3-2/3; or 3, >2/3 calcified) and scores were summed (0-12; Shemesh score). Conditional logistic regression determined the odds of CVD death by each score separately.
Results: Mean age was 72 yrs; 26% were women. The intra-reader and inter-reader kappa (any vs. 0) were 0.90 and 0.76 on 19 randomly selected scans. The median (IQR) Agatston CAC score were 315 (101, 1024) and 202 (5, 794) in cases and controls (P<0.05), whereas the corresponding median (IQR) Shemesh score were 3 (2, 4) and 2 (1, 3) (P< 0.05). The correlation of Agatston and Shemesh scores was 0.72 (p< 0.001). When adjusted for traditional CVD risk factors, the OR (95%CI) for CVD death per 1 SD greater Ln(CAC+1) was 1.57 (1.00-2.46) by Agatston on EBCT, and 1.66 (1.03-2.68) by Shemesh on standard chest CT. The odds of CVD death associated with any CAC vs. none was 2.23 (0.67-7.40) by Agatston, and 2.38 (0.81-6.97) by Shemesh.
Conclusions: A simple CAC scoring system using standard chest CT is strongly correlated with Agatston CAC on EBCT and provides similar prediction of CVD death in community-living individuals.
- © 2012 by American Heart Association, Inc.