Coronary Artery Calcium and Long-Term Risk of Death, Myocardial Infarction, and Stroke
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Objectives This study aimed to assess the long-term risk of death and atherosclerotic cardiovascular disease (ASCVD) outcomes, including stroke, in a real-world cohort that underwent coronary artery calcium (CAC) scoring. Background Large-scale, long-term studies assessing the independent relationship of CAC for prediction of ASCVD events, to include stroke, in young, low-risk patients are uncommon outside of the clinical trial setting. Methods A total of 23,637 consecutive subjects without ASCVD who underwent CAC scoring from 1997 to 2009 were studied. Subjects were assessed for myocardial infarction (MI), stroke, major adverse cardiovascular events (MACE) (e.g., MI, stroke, or cardiovascular death), and all-cause mortality. Outcomes were extracted from the Military Data Repository and the National Death Index and assessed using Cox proportional hazards models, controlling for baseline risk factors, atrial fibrillation, and competing mortality. Results Patients (mean age 50.0 ± 8.5 years) were followed over a median of 11.4 years. The relative adjusted subhazard ratio (aSHR) for CAC 1 to 100, 101 to 400, and >400 was 2.2, 3.8, and 5.9 for MI; 1.2, 1.4, and 1.9 for stroke; 1.4, 2.0, and 2.8 for MACE; and 1.2, 1.5 and 2.1 for death (p < 0.0001). The addition of CAC score to risk factors significantly improved the prognostic accuracy for all outcomes by the likelihood ratio test. Area under the curve increased from 0.658 to 0.738 for MI, 0.703 to 0.704 for stroke, 0.685 to 0.705 for MACE, and 0.759 to 0.767 for mortality. Among subjects without traditional risk factors (n = 6,208; mean age 43.8 ± 4.4 years), the presence of any CAC (>0; n = 848) was associated with an increased risk of MACE (aSHR: 1.67; 95% confidence interval: 1.16 to 2.39). Conclusions CAC scoring significantly improved long-term prognostic accuracy for MACE events and mortality, irrespective of age and risk factors. These results support CAC screening for improving individual ASCVD risk assessment and prevention in low-risk, young adults.
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There is increasing risk in the ordinal calcium score tiers identified by the deep learning system.
“Persons with a calcium score of zero are at very low risk24, with increasing risk in the ordinal calcium score tiers identified by the deep learning system25–27.”
From Deep convolutional neural networks to predict cardiovascular risk from computed tomography (2021) · cites this paper as [27]
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- Authors
- Mitchell, J. D., Paisley, R., Moon, P., Novak, E., & Villines, T. C.
- Affiliations
- Washington University in St. Louis (US)
- Baylor College of Medicine (US)
- Walter Reed National Military Medical Center (US)
- Corresponding author
- Villines, Todd C.
- Venue
- JACC: Cardiovascular Imaging
- Publisher
- Elsevier BV
- Published
- 2018-12
- Volume
- 11
- Issue
- 12
- Pages
- 1799-1806
- ISSN
- 1876-7591 (ISSN-L)
- 1936-878X
- OpenAlex
- W2770525978
- Cited by
- 107
- References
- 33
- Citations by year
- 2026: 9 · 2025: 9 · 2024: 15 · 2023: 10 · 2022: 15 · 2021: 18 · 2020: 17 · 2019: 10 · 2018: 4
- FWCI
- 6.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- JACC. Cardiovascular imaging (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Keywords
- coronary artery calcium, coronary artery calcium scoring, atherosclerotic cardiovascular disease, myocardial infarction, stroke, major adverse cardiovascular events, all-cause mortality, cardiovascular risk prediction, low-risk patients, young adults, prognostic accuracy, risk stratification, National Death Index, competing risk of death, atrial fibrillation
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Coronary Artery Disease, Female, Hospitals, Military, Humans, Male, Maryland, Middle Aged, Myocardial Infarction, Prognosis, Retrospective Studies, Risk Factors, Time Factors, Coronary Angiography, Risk Assessment, Stroke, Young Adult, Vascular Calcification
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