Abstract 10869: Multi-site Extracoronary Calcification Predicts Coronary Heart Disease Events and Mortality: The Multi-Ethnic Study of Atherosclerosis
INTRODUCTION: The prognostic value of multi-site extracoronary calcification (ECC) is not well characterized. We examined whether the number of ECC sites is associated with, and improves risk prediction for, incident coronary heart disease (CHD) and all-cause mortality.
METHODS: At baseline, calcification of the aortic valve, aortic root, mitral valve, and thoracic aorta were measured by computed tomography in 5,901 MESA participants without diabetes, who were followed for a median of 8.5 years for incident CHD events and all-cause mortality. Multivariable adjusted hazard ratios estimated the risk associated with increasing number of ECC sites (0, 1, 2, 3 and 4), and receiver operator characteristic (ROC) analysis assessed model discrimination.
RESULTS: At baseline 53% of the cohort was female and 45% had prevalent ECC. Increasing number of ECC sites had a positive and graded association with CHD events and mortality, independent of risk factors and coronary artery calcium (CAC). Independent of CAC, those with ECC in two or three sites had about 50% greater risk for both CHD events and mortality compared to those without ECC (all p≤0.05); while the risk of ECC in four sites was 2.1 (95% CI 1.2-3.7) and 2.6 (95% CI 1.7-4.1) for CHD events and mortality, respectively. When modeled as a binary variable and added to risk factors alone, “any ECC” also significantly increased the risk for both outcomes. In ROC analysis, ECC significantly increased the area under the curve for both CHD events (0.746 to 0.765) and mortality (0.791 to 0.797; both p≤0.01) when added to a model with traditional risk factors alone, and did so for mortality when added to risk factors and CAC (0.794 to 0.798; p=0.037).
CONCLUSION: Multi-site ECC is a significant independent predictor of CHD events and mortality beyond traditional risk factors and CAC, and an incidental finding of “any ECC” may also be associated with higher CHD and mortality risk. ECC improves risk prediction for both CHD events and mortality.
- © 2013 by American Heart Association, Inc.