Abstract 16588: Thoracic Aorta, Aortic Valve and Mitral Annular Calcifications Present No Incremental Risk for All Cause Mortality in the Presence of Coronary Artery Calcium

Abstract

Background: Coronary artery calcium (CAC) and extra-coronary calcification (ECC) sites - thoracic aortic calcium (TAC), aortic valvular calcium (AVC) and mitral annular calcifications (MAC) - have been associated with adverse prognosis. We sought to explore whether ECC sites, separately or in combination, have incremental predictive value for all cause mortality (ACM) over CAC score.

Methods: We evaluated 8404 consecutive patients (mean age 54 years, 64% male gender, mean follow up 6.5 years) without known coronary artery disease (CAD), who underwent noncontrast cardiac CT scan. CAC and ECC were assessed for presence and magnitude using the Agatston score. Log transformation was employed due to the non-normal distribution of Agatston scores. Chi squared tests were employed to evaluate trends across ordered groups of ECC sites. Cox regression models were employed to predict ACM, adjusting for traditional risk factors and CAC score (presence vs. absence, or log-transformed).

Results: 160 deaths (1.9%) occurred during the follow up period. 3830 subjects (46%) had a CAC score >0. In univariate analysis, presence of CAC, TAC, AVC and MAC were each associated with higher ACM (Table 1). As compared to subjects without ECC, the 2906 subjects (35%) with 1, 2 and 3 ECC sites were older, with greater prevalence of hypertension, diabetes mellitus, higher CAC scores and ACM (3.5% vs. 1%, p<0.001). In a multivariable Cox analysis, presence and magnitude of CAC and AVC were independent predictors of ACM. In the subset of subjects with CAC>0 (n=3830), presence or magnitude of TAC, AVC and MAC, alone or in combination, were not predictive of ACM.

Conclusion: CAC and AVC, but not TAC or MAC, are independent predictors of all cause mortality. In the presence of CAC, however, AVC, or combination of several ECC sites, offers no incremental prognostic value.