Calcium score, coronary artery disease extent and severity, and clinical outcomes among low Framingham risk patients with low vs high lifetime risk: Results from the CONFIRM registry

Edward Hulten; Todd C. Villines; Michael K. Cheezum; Daniel S. Berman; Allison Dunning; Stephan Achenbach; Mouaz Al-Mallah; Matthew J. Budoff; Filippo Cademartiri; Tracy Q. Callister; Hyuk Jae Chang; Victor Y. Cheng; Kavitha Chinnaiyan; Benjamin J.W. Chow; Ricardo C. Cury; Augustin Delago; Gudrun Feuchtner; Martin Hadamitzky; Jörg Hausleiter; Philipp A. Kaufmann; Yong Jin Kim; Jonathon Leipsic; Fay Y. Lin; Erica Maffei; Fabian Plank; Gilbert L. Raff; Leslee J. Shaw; James K. Min

doi:10.1007/s12350-013-9819-7

Calcium score, coronary artery disease extent and severity, and clinical outcomes among low Framingham risk patients with low vs high lifetime risk: Results from the CONFIRM registry

Edward Hulten, Todd C. Villines, Michael K. Cheezum, Daniel S. Berman, Allison Dunning, Stephan Achenbach, Mouaz Al-Mallah, Matthew J. Budoff, Filippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Victor Y. Cheng, Kavitha Chinnaiyan, Benjamin J.W. Chow, Ricardo C. Cury, Augustin Delago, Gudrun Feuchtner, Martin Hadamitzky, Jörg Hausleiter, Philipp A. KaufmannYong Jin Kim, Jonathon Leipsic, Fay Y. Lin, Erica Maffei, Fabian Plank, Gilbert L. Raff, Leslee J. Shaw, James K. Min

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

18 Citations (Scopus)

Abstract

Background: Short-term risk scores, such as the Framingham risk score (FRS), frequently classify younger patients as low risk despite the presence of uncontrolled cardiovascular risk factors. Among patients with low FRS, estimation of lifetime risk is associated with significant differences in coronary arterial calcium scores (CACS); however, the relationship of lifetime risk to coronary atherosclerosis on coronary CT angiography (CCTA) and prognosis has not been studied. Methods and Results: We evaluated asymptomatic 20-60-year-old patients without diabetes or known coronary artery disease (CAD) within an international CT registry who underwent ≥64-slice CCTA. Patients with low FRS (<10%) were stratified as low (<39%) or high (≥39%) lifetime CAD risk, and compared for the presence and severity of CAD and prognosis for death, myocardial infarction, and late coronary revascularization (>90 days post CCTA). 1,863 patients of mean age of 47 years were included, with 48% of the low FRS patients at high lifetime risk. Median follow-up was 2.0 years. Comparing low-to-high lifetime risk, respectively, the prevalence of any CAD was 32% vs 41% (P <.001) and ≥50% stenosis was 7.4% vs 9.6% (P =.09). For those with CAD, subjects at low vs high lifetime risk had lower CACS (median 12 [IQR 0-94] vs 38 [IQR 0.05-144], P =.02) and less purely calcified plaque, 35% vs 45% (P <.001). Prognosis did not differ due to low number of events. Conclusion: Assessment of lifetime risk among patients at low FRS identified those with the increase in CAD prevalence and severity and a higher proportion of calcified plaque.

Original language	English
Pages (from-to)	29-37
Number of pages	9
Journal	Journal of Nuclear Cardiology
Volume	21
Issue number	1
DOIs	https://doi.org/10.1007/s12350-013-9819-7
Publication status	Published - 2014 Feb

Bibliographical note

Funding Information:
Dr Villines has received speaker’s honoraria from Boehringer-Ingelheim, Ingelheim, Germany. Dr Achenbach has received grant support from Siemens Healthcare, Erlan-gen, Germany, and Bayer Schering Pharma AG, Berlin, Germany. Dr Budoff has received speaker’s honoraria from GE Healthcare, Milwaukee, Wisconsin. Dr Cademartiri has received grant support from GE Healthcare and speaker’s honoraria from Bracco Diagnostics, Milan, Italy. Dr Callister is on the speaker’s bureau of GE Healthcare. Dr Chinnaiyan has received grant support from Bayer Pharma AG, Berlin, Germany, and Blue Cross Blue Shield Blue Care Michigan. Dr Chow has received research support from GE Healthcare; Pfizer, Inc., New York, New York; and AstraZeneca, Wilmington, Delaware. Dr Chow has received educational support from TeraRecon, Foster City, California. Dr Hausleiter has received research grant support from Siemens Healthcare. Dr Kaufmann has received research support from GE Healthcare and grant support from the Swiss National Science Foundation, Bern, Switzerland. Dr Maffei has received grant support from GE Healthcare and is a consultant for Servier, Neuilly-sur-Seine, France. Dr Raff has received grant support from Siemens Healthcare, Blue Cross Blue Shield Blue Care Michigan, and Bayer Pharma AG. Dr Min has received speaker’s honoraria and research support from and serves on the medical advisory board of GE Healthcare. The views expressed here are those of the investigators only and are not to be construed as those of the United States Department of the Army or Department of Defense.

All Science Journal Classification (ASJC) codes

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s12350-013-9819-7

Cite this

Hulten, E., Villines, T. C., Cheezum, M. K., Berman, D. S., Dunning, A., Achenbach, S., Al-Mallah, M., Budoff, M. J., Cademartiri, F., Callister, T. Q., Chang, H. J., Cheng, V. Y., Chinnaiyan, K., Chow, B. J. W., Cury, R. C., Delago, A., Feuchtner, G., Hadamitzky, M., Hausleiter, J., ... Min, J. K. (2014). Calcium score, coronary artery disease extent and severity, and clinical outcomes among low Framingham risk patients with low vs high lifetime risk: Results from the CONFIRM registry. Journal of Nuclear Cardiology, 21(1), 29-37. https://doi.org/10.1007/s12350-013-9819-7

@article{71d3805a528d4a6ca8b5fbeb43dcc454,

title = "Calcium score, coronary artery disease extent and severity, and clinical outcomes among low Framingham risk patients with low vs high lifetime risk: Results from the CONFIRM registry",

abstract = "Background: Short-term risk scores, such as the Framingham risk score (FRS), frequently classify younger patients as low risk despite the presence of uncontrolled cardiovascular risk factors. Among patients with low FRS, estimation of lifetime risk is associated with significant differences in coronary arterial calcium scores (CACS); however, the relationship of lifetime risk to coronary atherosclerosis on coronary CT angiography (CCTA) and prognosis has not been studied. Methods and Results: We evaluated asymptomatic 20-60-year-old patients without diabetes or known coronary artery disease (CAD) within an international CT registry who underwent ≥64-slice CCTA. Patients with low FRS (<10%) were stratified as low (<39%) or high (≥39%) lifetime CAD risk, and compared for the presence and severity of CAD and prognosis for death, myocardial infarction, and late coronary revascularization (>90 days post CCTA). 1,863 patients of mean age of 47 years were included, with 48% of the low FRS patients at high lifetime risk. Median follow-up was 2.0 years. Comparing low-to-high lifetime risk, respectively, the prevalence of any CAD was 32% vs 41% (P <.001) and ≥50% stenosis was 7.4% vs 9.6% (P =.09). For those with CAD, subjects at low vs high lifetime risk had lower CACS (median 12 [IQR 0-94] vs 38 [IQR 0.05-144], P =.02) and less purely calcified plaque, 35% vs 45% (P <.001). Prognosis did not differ due to low number of events. Conclusion: Assessment of lifetime risk among patients at low FRS identified those with the increase in CAD prevalence and severity and a higher proportion of calcified plaque.",

author = "Edward Hulten and Villines, {Todd C.} and Cheezum, {Michael K.} and Berman, {Daniel S.} and Allison Dunning and Stephan Achenbach and Mouaz Al-Mallah and Budoff, {Matthew J.} and Filippo Cademartiri and Callister, {Tracy Q.} and Chang, {Hyuk Jae} and Cheng, {Victor Y.} and Kavitha Chinnaiyan and Chow, {Benjamin J.W.} and Cury, {Ricardo C.} and Augustin Delago and Gudrun Feuchtner and Martin Hadamitzky and J{\"o}rg Hausleiter and Kaufmann, {Philipp A.} and Kim, {Yong Jin} and Jonathon Leipsic and Lin, {Fay Y.} and Erica Maffei and Fabian Plank and Raff, {Gilbert L.} and Shaw, {Leslee J.} and Min, {James K.}",

note = "Funding Information: Dr Villines has received speaker{\textquoteright}s honoraria from Boehringer-Ingelheim, Ingelheim, Germany. Dr Achenbach has received grant support from Siemens Healthcare, Erlan-gen, Germany, and Bayer Schering Pharma AG, Berlin, Germany. Dr Budoff has received speaker{\textquoteright}s honoraria from GE Healthcare, Milwaukee, Wisconsin. Dr Cademartiri has received grant support from GE Healthcare and speaker{\textquoteright}s honoraria from Bracco Diagnostics, Milan, Italy. Dr Callister is on the speaker{\textquoteright}s bureau of GE Healthcare. Dr Chinnaiyan has received grant support from Bayer Pharma AG, Berlin, Germany, and Blue Cross Blue Shield Blue Care Michigan. Dr Chow has received research support from GE Healthcare; Pfizer, Inc., New York, New York; and AstraZeneca, Wilmington, Delaware. Dr Chow has received educational support from TeraRecon, Foster City, California. Dr Hausleiter has received research grant support from Siemens Healthcare. Dr Kaufmann has received research support from GE Healthcare and grant support from the Swiss National Science Foundation, Bern, Switzerland. Dr Maffei has received grant support from GE Healthcare and is a consultant for Servier, Neuilly-sur-Seine, France. Dr Raff has received grant support from Siemens Healthcare, Blue Cross Blue Shield Blue Care Michigan, and Bayer Pharma AG. Dr Min has received speaker{\textquoteright}s honoraria and research support from and serves on the medical advisory board of GE Healthcare. The views expressed here are those of the investigators only and are not to be construed as those of the United States Department of the Army or Department of Defense.",

year = "2014",

month = feb,

doi = "10.1007/s12350-013-9819-7",

language = "English",

volume = "21",

pages = "29--37",

journal = "Journal of Nuclear Cardiology",

issn = "1071-3581",

publisher = "Springer New York",

number = "1",

}

Hulten, E, Villines, TC, Cheezum, MK, Berman, DS, Dunning, A, Achenbach, S, Al-Mallah, M, Budoff, MJ, Cademartiri, F, Callister, TQ, Chang, HJ, Cheng, VY, Chinnaiyan, K, Chow, BJW, Cury, RC, Delago, A, Feuchtner, G, Hadamitzky, M, Hausleiter, J, Kaufmann, PA, Kim, YJ, Leipsic, J, Lin, FY, Maffei, E, Plank, F, Raff, GL, Shaw, LJ & Min, JK 2014, 'Calcium score, coronary artery disease extent and severity, and clinical outcomes among low Framingham risk patients with low vs high lifetime risk: Results from the CONFIRM registry', Journal of Nuclear Cardiology, vol. 21, no. 1, pp. 29-37. https://doi.org/10.1007/s12350-013-9819-7

Calcium score, coronary artery disease extent and severity, and clinical outcomes among low Framingham risk patients with low vs high lifetime risk: Results from the CONFIRM registry. / Hulten, Edward; Villines, Todd C.; Cheezum, Michael K. et al.
In: Journal of Nuclear Cardiology, Vol. 21, No. 1, 02.2014, p. 29-37.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Calcium score, coronary artery disease extent and severity, and clinical outcomes among low Framingham risk patients with low vs high lifetime risk

T2 - Results from the CONFIRM registry

AU - Hulten, Edward

AU - Villines, Todd C.

AU - Cheezum, Michael K.

AU - Berman, Daniel S.

AU - Dunning, Allison

AU - Achenbach, Stephan

AU - Al-Mallah, Mouaz

AU - Budoff, Matthew J.

AU - Cademartiri, Filippo

AU - Callister, Tracy Q.

AU - Chang, Hyuk Jae

AU - Cheng, Victor Y.

AU - Chinnaiyan, Kavitha

AU - Chow, Benjamin J.W.

AU - Cury, Ricardo C.

AU - Delago, Augustin

AU - Feuchtner, Gudrun

AU - Hadamitzky, Martin

AU - Hausleiter, Jörg

AU - Kaufmann, Philipp A.

AU - Kim, Yong Jin

AU - Leipsic, Jonathon

AU - Lin, Fay Y.

AU - Maffei, Erica

AU - Plank, Fabian

AU - Raff, Gilbert L.

AU - Shaw, Leslee J.

AU - Min, James K.

N1 - Funding Information: Dr Villines has received speaker’s honoraria from Boehringer-Ingelheim, Ingelheim, Germany. Dr Achenbach has received grant support from Siemens Healthcare, Erlan-gen, Germany, and Bayer Schering Pharma AG, Berlin, Germany. Dr Budoff has received speaker’s honoraria from GE Healthcare, Milwaukee, Wisconsin. Dr Cademartiri has received grant support from GE Healthcare and speaker’s honoraria from Bracco Diagnostics, Milan, Italy. Dr Callister is on the speaker’s bureau of GE Healthcare. Dr Chinnaiyan has received grant support from Bayer Pharma AG, Berlin, Germany, and Blue Cross Blue Shield Blue Care Michigan. Dr Chow has received research support from GE Healthcare; Pfizer, Inc., New York, New York; and AstraZeneca, Wilmington, Delaware. Dr Chow has received educational support from TeraRecon, Foster City, California. Dr Hausleiter has received research grant support from Siemens Healthcare. Dr Kaufmann has received research support from GE Healthcare and grant support from the Swiss National Science Foundation, Bern, Switzerland. Dr Maffei has received grant support from GE Healthcare and is a consultant for Servier, Neuilly-sur-Seine, France. Dr Raff has received grant support from Siemens Healthcare, Blue Cross Blue Shield Blue Care Michigan, and Bayer Pharma AG. Dr Min has received speaker’s honoraria and research support from and serves on the medical advisory board of GE Healthcare. The views expressed here are those of the investigators only and are not to be construed as those of the United States Department of the Army or Department of Defense.

PY - 2014/2

Y1 - 2014/2

N2 - Background: Short-term risk scores, such as the Framingham risk score (FRS), frequently classify younger patients as low risk despite the presence of uncontrolled cardiovascular risk factors. Among patients with low FRS, estimation of lifetime risk is associated with significant differences in coronary arterial calcium scores (CACS); however, the relationship of lifetime risk to coronary atherosclerosis on coronary CT angiography (CCTA) and prognosis has not been studied. Methods and Results: We evaluated asymptomatic 20-60-year-old patients without diabetes or known coronary artery disease (CAD) within an international CT registry who underwent ≥64-slice CCTA. Patients with low FRS (<10%) were stratified as low (<39%) or high (≥39%) lifetime CAD risk, and compared for the presence and severity of CAD and prognosis for death, myocardial infarction, and late coronary revascularization (>90 days post CCTA). 1,863 patients of mean age of 47 years were included, with 48% of the low FRS patients at high lifetime risk. Median follow-up was 2.0 years. Comparing low-to-high lifetime risk, respectively, the prevalence of any CAD was 32% vs 41% (P <.001) and ≥50% stenosis was 7.4% vs 9.6% (P =.09). For those with CAD, subjects at low vs high lifetime risk had lower CACS (median 12 [IQR 0-94] vs 38 [IQR 0.05-144], P =.02) and less purely calcified plaque, 35% vs 45% (P <.001). Prognosis did not differ due to low number of events. Conclusion: Assessment of lifetime risk among patients at low FRS identified those with the increase in CAD prevalence and severity and a higher proportion of calcified plaque.

AB - Background: Short-term risk scores, such as the Framingham risk score (FRS), frequently classify younger patients as low risk despite the presence of uncontrolled cardiovascular risk factors. Among patients with low FRS, estimation of lifetime risk is associated with significant differences in coronary arterial calcium scores (CACS); however, the relationship of lifetime risk to coronary atherosclerosis on coronary CT angiography (CCTA) and prognosis has not been studied. Methods and Results: We evaluated asymptomatic 20-60-year-old patients without diabetes or known coronary artery disease (CAD) within an international CT registry who underwent ≥64-slice CCTA. Patients with low FRS (<10%) were stratified as low (<39%) or high (≥39%) lifetime CAD risk, and compared for the presence and severity of CAD and prognosis for death, myocardial infarction, and late coronary revascularization (>90 days post CCTA). 1,863 patients of mean age of 47 years were included, with 48% of the low FRS patients at high lifetime risk. Median follow-up was 2.0 years. Comparing low-to-high lifetime risk, respectively, the prevalence of any CAD was 32% vs 41% (P <.001) and ≥50% stenosis was 7.4% vs 9.6% (P =.09). For those with CAD, subjects at low vs high lifetime risk had lower CACS (median 12 [IQR 0-94] vs 38 [IQR 0.05-144], P =.02) and less purely calcified plaque, 35% vs 45% (P <.001). Prognosis did not differ due to low number of events. Conclusion: Assessment of lifetime risk among patients at low FRS identified those with the increase in CAD prevalence and severity and a higher proportion of calcified plaque.

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U2 - 10.1007/s12350-013-9819-7

DO - 10.1007/s12350-013-9819-7

M3 - Article

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AN - SCOPUS:84893868762

SN - 1071-3581

VL - 21

SP - 29

EP - 37

JO - Journal of Nuclear Cardiology

JF - Journal of Nuclear Cardiology

IS - 1

ER -

Calcium score, coronary artery disease extent and severity, and clinical outcomes among low Framingham risk patients with low vs high lifetime risk: Results from the CONFIRM registry

Abstract

Bibliographical note

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UN SDGs

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