Abstract 16608: Role of Extra-coronary Calcification on Cardiac-gated Computed Tomography in the Prediction of Stroke: a Multi-Ethnic Study of Atherosclerosis
Introduction: Atherosclerosis is a systemic disease but may have a predilection for certain locations, which may be predictive of specific cardiovascular events. For example, coronary artery calcification (CAC) is a stronger predictor of coronary heart disease than stroke. The association between extra-coronary calcification (ECC) and individual stroke-related events is not well described.
Hypothesis: ECC, which may appear in the absence of CAC, can improve prediction of stroke when added to traditional cardiovascular risk factors and CAC.
Methods: Cardiac-gated computed tomography scans in Multi-Ethnic Study of Atherosclerosis were reviewed for the presence (1) or absence (0) of calcification at mitral valve (annulus), aortic valve, aortic root, and thoracic aorta. Multisite ECC score, ranging from 0-4, was calculated by summing the 4 individual ECC sites. Participants were followed for incident stroke and stroke mortality. Cox proportional hazard models were built to estimate hazard ratios according to ECC. The ability of ECC to discriminate and reclassify risk was also assessed.
Results: A total of 6,805 participants were followed over a median of 12.1 years for incident total stroke (n=235), ischemic stroke (n=184), hemorrhagic stroke (n=32), transient ischemic attack (TIA) (n=85), and stroke mortality (n=42). With increasing ECC sites, there was a significant step-wise increase in the risk for total stroke, ischemic stroke, and TIA, but not hemorrhagic stroke and stroke mortality. (Table) ECC increased c-statistic and net reclassification index beyond traditional risk factors and CAC, but results were not significant. Integrated discrimination improvement was significant for ischemic stroke (0.0023; P= 0.005).
Conclusions: Multisite ECC can predict the risk for total stroke, ischemic stroke, and TIA and may modestly improve risk prediction for ischemic stroke over traditional risk factors and CAC.
Author Disclosures: S. Kianoush: None. M. Al-Rifai: None. M. Cainzos-Achirica: None. M. Al-Mallah: None. G.H. Tison: None. J. Yeboah: None. M.D. Miedema: None. M.A. Allison: None. N.D. Wong: None. A.P. DeFilippis: Speakers Bureau; Modest; Astra Zeneca. Research Grant; Significant; Astra Zeneca. K. Nasir: None. W. Longstreth: None. M.J. Budoff: None. K. Matsushita: None. M.J. Blaha: None.
- © 2016 by American Heart Association, Inc.