The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry)

Ji Hyun Lee; Asim Rizvi; Bríain Hartaigh; Donghee Han; Mahn Won Park; Hadi Mirhedayati Roudsari; Wijnand J. Stuijfzand; Heidi Gransar; Yao Lu; Tracy Q. Callister; Daniel S. Berman; Augustin DeLago; Martin Hadamitzky; Joerg Hausleiter; Mouaz H. Al-Mallah; Matthew J. Budoff; Philipp A. Kaufmann; Gilbert L. Raff; Kavitha Chinnaiyan; Filippo Cademartiri; Erica Maffei; Todd C. Villines; Yong Jin Kim; Jonathon Leipsic; Gudrun Feuchtner; Gianluca Pontone; Daniele Andreini; Hugo Marques; Pedro de Araújo Gonçalves; Ronen Rubinshtein; Stephan Achenbach; Leslee J. Shaw; Benjamin J.W. Chow; Ricardo C. Cury; Jeroen J. Bax; Hyuk Jae Chang; Erica C. Jones; Fay Y. Lin; James K. Min; Jessica M. Peña

doi:10.1016/j.amjcard.2019.01.055

The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry)

Ji Hyun Lee, Asim Rizvi, Bríain Hartaigh, Donghee Han, Mahn Won Park, Hadi Mirhedayati Roudsari, Wijnand J. Stuijfzand, Heidi Gransar, Yao Lu, Tracy Q. Callister, Daniel S. Berman, Augustin DeLago, Martin Hadamitzky, Joerg Hausleiter, Mouaz H. Al-Mallah, Matthew J. Budoff, Philipp A. Kaufmann, Gilbert L. Raff, Kavitha Chinnaiyan, Filippo CademartiriErica Maffei, Todd C. Villines, Yong Jin Kim, Jonathon Leipsic, Gudrun Feuchtner, Gianluca Pontone, Daniele Andreini, Hugo Marques, Pedro de Araújo Gonçalves, Ronen Rubinshtein, Stephan Achenbach, Leslee J. Shaw, Benjamin J.W. Chow, Ricardo C. Cury, Jeroen J. Bax, Hyuk Jae Chang, Erica C. Jones, Fay Y. Lin, James K. Min, Jessica M. Peña

Department of Internal Medicine

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

9 Citations (Scopus)

Abstract

The prognostic performance of coronary artery calcium score (CACS) for predicting adverse outcomes in patients with decreased renal function remains unclear. We aimed to examine whether CACS improves risk stratification by demonstrating incremental value beyond a traditional risk score according to renal function status. 9,563 individuals without known coronary artery disease were enrolled. Estimated glomerular filtration rate (eGFR, ml/min/1.73 m ² ) was ascertained using the modified Modification of Diet in Renal Disease formula, and was categorized as: ≥90, 60 to 89, and <60. CACS was categorized as 0, 1 to 100, 101 to 400, and >400. Multivariable Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (95% CI) for major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, and late revascularization (>90 days). Mean age was 55.8 ± 11.5 years (52.8% male). In total, 261 (2.7%) patients experienced MACE over a median follow-up of 24.5 months (interquartile range: 16.9 to 41.1). Incident MACE increased with higher CACS across each eGFR category, with the highest rate observed among patients with CACS >400 and eGFR <60 (95.1 per 1,000 person-years). A CACS >400 increased MACE risk with HR 4.46 (95% CI 1.68 to 11.85), 6.63 (95% CI 4.03 to 10.92), and 6.14 (95% CI 2.85 to 13.21) for eGFR ≥90, 60 to 89, and <60, respectively, as compared with CACS 0. Further, CACS improved discrimination and reclassification beyond Framingham 10-year risk score (FRS) (AUC: 0.70 vs 0.64; category free-NRI: 0.51, all p <0.001) for predicting MACE in patients with impaired renal function (eGFR < 90). In conclusion, CACS improved risk stratification and provided incremental value beyond FRS for predicting MACE, irrespective of eGFR status.

Original language	English
Pages (from-to)	1435-1442
Number of pages	8
Journal	American Journal of Cardiology
Volume	123
Issue number	9
DOIs	https://doi.org/10.1016/j.amjcard.2019.01.055
Publication status	Published - 2019 May 1

Bibliographical note

Funding Information:
The research reported in this publication was supported by the National Institutes of Health (Bethesda, Maryland) under grant number R01 HL115150. The research was also supported, in part, by a generous gift from the Dalio Institute of Cardiovascular Imaging (New York, New York) and the Michael Wolk Foundation (New York, New York). Further, this research was supported by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (MSIT) grant number 2012027176. The research reported in this publication was supported by the National Institutes of Health (Bethesda, Maryland) under grant number R01 HL115150. The research was also supported, in part, by a generous gift from the Dalio Institute of Cardiovascular Imaging (New York, New York) and the Michael Wolk Foundation (New York, New York). Further, this research was supported by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (MSIT) grant number 2012027176.

Funding Information:
The research reported in this publication was supported by the National Institutes of Health (Bethesda, Maryland) under grant number R01 HL115150 . The research was also supported, in part, by a generous gift from the Dalio Institute of Cardiovascular Imaging (New York, New York) and the Michael Wolk Foundation (New York, New York). Further, this research was supported by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (MSIT) grant number 2012027176 .

Funding Information:
Dr. James K. Min receives funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare. Dr. Min serves on the scientific advisory board of Arineta and GE Healthcare, and has an equity interest in Cleerly. Dr. Gianluca Pontone is a member of the speakers’ bureau for GE Healthcare, Bracco, and Medtronic. He also conducts research for GE Healthcare and Heartflow. Dr. Matthew Budoff receives grant support from GE Healthcare and the NIH. All other authors have no relevant disclosures.

Publisher Copyright:
© 2019

All Science Journal Classification (ASJC) codes

Cardiology and Cardiovascular Medicine

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Lee, J. H., Rizvi, A., Hartaigh, B., Han, D., Park, M. W., Roudsari, H. M., Stuijfzand, W. J., Gransar, H., Lu, Y., Callister, T. Q., Berman, D. S., DeLago, A., Hadamitzky, M., Hausleiter, J., Al-Mallah, M. H., Budoff, M. J., Kaufmann, P. A., Raff, G. L., Chinnaiyan, K., ... Peña, J. M. (2019). The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry). American Journal of Cardiology, 123(9), 1435-1442. https://doi.org/10.1016/j.amjcard.2019.01.055

Lee, Ji Hyun ; Rizvi, Asim ; Hartaigh, Bríain et al. / The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry). In: American Journal of Cardiology. 2019 ; Vol. 123, No. 9. pp. 1435-1442.

@article{8187c711855f4d1e99d95a693777e046,

title = "The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry)",

abstract = " The prognostic performance of coronary artery calcium score (CACS) for predicting adverse outcomes in patients with decreased renal function remains unclear. We aimed to examine whether CACS improves risk stratification by demonstrating incremental value beyond a traditional risk score according to renal function status. 9,563 individuals without known coronary artery disease were enrolled. Estimated glomerular filtration rate (eGFR, ml/min/1.73 m 2 ) was ascertained using the modified Modification of Diet in Renal Disease formula, and was categorized as: ≥90, 60 to 89, and <60. CACS was categorized as 0, 1 to 100, 101 to 400, and >400. Multivariable Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (95% CI) for major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, and late revascularization (>90 days). Mean age was 55.8 ± 11.5 years (52.8% male). In total, 261 (2.7%) patients experienced MACE over a median follow-up of 24.5 months (interquartile range: 16.9 to 41.1). Incident MACE increased with higher CACS across each eGFR category, with the highest rate observed among patients with CACS >400 and eGFR <60 (95.1 per 1,000 person-years). A CACS >400 increased MACE risk with HR 4.46 (95% CI 1.68 to 11.85), 6.63 (95% CI 4.03 to 10.92), and 6.14 (95% CI 2.85 to 13.21) for eGFR ≥90, 60 to 89, and <60, respectively, as compared with CACS 0. Further, CACS improved discrimination and reclassification beyond Framingham 10-year risk score (FRS) (AUC: 0.70 vs 0.64; category free-NRI: 0.51, all p <0.001) for predicting MACE in patients with impaired renal function (eGFR < 90). In conclusion, CACS improved risk stratification and provided incremental value beyond FRS for predicting MACE, irrespective of eGFR status.",

author = "Lee, {Ji Hyun} and Asim Rizvi and Br{\'i}ain Hartaigh and Donghee Han and Park, {Mahn Won} and Roudsari, {Hadi Mirhedayati} and Stuijfzand, {Wijnand J.} and Heidi Gransar and Yao Lu and Callister, {Tracy Q.} and Berman, {Daniel S.} and Augustin DeLago and Martin Hadamitzky and Joerg Hausleiter and Al-Mallah, {Mouaz H.} and Budoff, {Matthew J.} and Kaufmann, {Philipp A.} and Raff, {Gilbert L.} and Kavitha Chinnaiyan and Filippo Cademartiri and Erica Maffei and Villines, {Todd C.} and Kim, {Yong Jin} and Jonathon Leipsic and Gudrun Feuchtner and Gianluca Pontone and Daniele Andreini and Hugo Marques and {de Ara{\'u}jo Gon{\c c}alves}, Pedro and Ronen Rubinshtein and Stephan Achenbach and Shaw, {Leslee J.} and Chow, {Benjamin J.W.} and Cury, {Ricardo C.} and Bax, {Jeroen J.} and Chang, {Hyuk Jae} and Jones, {Erica C.} and Lin, {Fay Y.} and Min, {James K.} and Pe{\~n}a, {Jessica M.}",

note = "Funding Information: The research reported in this publication was supported by the National Institutes of Health (Bethesda, Maryland) under grant number R01 HL115150. The research was also supported, in part, by a generous gift from the Dalio Institute of Cardiovascular Imaging (New York, New York) and the Michael Wolk Foundation (New York, New York). Further, this research was supported by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (MSIT) grant number 2012027176. The research reported in this publication was supported by the National Institutes of Health (Bethesda, Maryland) under grant number R01 HL115150. The research was also supported, in part, by a generous gift from the Dalio Institute of Cardiovascular Imaging (New York, New York) and the Michael Wolk Foundation (New York, New York). Further, this research was supported by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (MSIT) grant number 2012027176. Funding Information: The research reported in this publication was supported by the National Institutes of Health (Bethesda, Maryland) under grant number R01 HL115150 . The research was also supported, in part, by a generous gift from the Dalio Institute of Cardiovascular Imaging (New York, New York) and the Michael Wolk Foundation (New York, New York). Further, this research was supported by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (MSIT) grant number 2012027176 . Funding Information: Dr. James K. Min receives funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare. Dr. Min serves on the scientific advisory board of Arineta and GE Healthcare, and has an equity interest in Cleerly. Dr. Gianluca Pontone is a member of the speakers{\textquoteright} bureau for GE Healthcare, Bracco, and Medtronic. He also conducts research for GE Healthcare and Heartflow. Dr. Matthew Budoff receives grant support from GE Healthcare and the NIH. All other authors have no relevant disclosures. Publisher Copyright: {\textcopyright} 2019",

year = "2019",

month = may,

day = "1",

doi = "10.1016/j.amjcard.2019.01.055",

language = "English",

volume = "123",

pages = "1435--1442",

journal = "American Journal of Cardiology",

issn = "0002-9149",

publisher = "Elsevier Inc.",

number = "9",

}

Lee, JH, Rizvi, A, Hartaigh, B, Han, D, Park, MW, Roudsari, HM, Stuijfzand, WJ, Gransar, H, Lu, Y, Callister, TQ, Berman, DS, DeLago, A, Hadamitzky, M, Hausleiter, J, Al-Mallah, MH, Budoff, MJ, Kaufmann, PA, Raff, GL, Chinnaiyan, K, Cademartiri, F, Maffei, E, Villines, TC, Kim, YJ, Leipsic, J, Feuchtner, G, Pontone, G, Andreini, D, Marques, H, de Araújo Gonçalves, P, Rubinshtein, R, Achenbach, S, Shaw, LJ, Chow, BJW, Cury, RC, Bax, JJ, Chang, HJ, Jones, EC, Lin, FY, Min, JK & Peña, JM 2019, 'The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry)', American Journal of Cardiology, vol. 123, no. 9, pp. 1435-1442. https://doi.org/10.1016/j.amjcard.2019.01.055

The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry). / Lee, Ji Hyun; Rizvi, Asim; Hartaigh, Bríain et al.
In: American Journal of Cardiology, Vol. 123, No. 9, 01.05.2019, p. 1435-1442.

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

TY - JOUR

T1 - The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry)

AU - Lee, Ji Hyun

AU - Rizvi, Asim

AU - Hartaigh, Bríain

AU - Han, Donghee

AU - Park, Mahn Won

AU - Roudsari, Hadi Mirhedayati

AU - Stuijfzand, Wijnand J.

AU - Gransar, Heidi

AU - Lu, Yao

AU - Callister, Tracy Q.

AU - Berman, Daniel S.

AU - DeLago, Augustin

AU - Hadamitzky, Martin

AU - Hausleiter, Joerg

AU - Al-Mallah, Mouaz H.

AU - Budoff, Matthew J.

AU - Kaufmann, Philipp A.

AU - Raff, Gilbert L.

AU - Chinnaiyan, Kavitha

AU - Cademartiri, Filippo

AU - Maffei, Erica

AU - Villines, Todd C.

AU - Kim, Yong Jin

AU - Leipsic, Jonathon

AU - Feuchtner, Gudrun

AU - Pontone, Gianluca

AU - Andreini, Daniele

AU - Marques, Hugo

AU - de Araújo Gonçalves, Pedro

AU - Rubinshtein, Ronen

AU - Achenbach, Stephan

AU - Shaw, Leslee J.

AU - Chow, Benjamin J.W.

AU - Cury, Ricardo C.

AU - Bax, Jeroen J.

AU - Chang, Hyuk Jae

AU - Jones, Erica C.

AU - Lin, Fay Y.

AU - Min, James K.

AU - Peña, Jessica M.

N1 - Funding Information: The research reported in this publication was supported by the National Institutes of Health (Bethesda, Maryland) under grant number R01 HL115150. The research was also supported, in part, by a generous gift from the Dalio Institute of Cardiovascular Imaging (New York, New York) and the Michael Wolk Foundation (New York, New York). Further, this research was supported by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (MSIT) grant number 2012027176. The research reported in this publication was supported by the National Institutes of Health (Bethesda, Maryland) under grant number R01 HL115150. The research was also supported, in part, by a generous gift from the Dalio Institute of Cardiovascular Imaging (New York, New York) and the Michael Wolk Foundation (New York, New York). Further, this research was supported by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (MSIT) grant number 2012027176. Funding Information: The research reported in this publication was supported by the National Institutes of Health (Bethesda, Maryland) under grant number R01 HL115150 . The research was also supported, in part, by a generous gift from the Dalio Institute of Cardiovascular Imaging (New York, New York) and the Michael Wolk Foundation (New York, New York). Further, this research was supported by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (MSIT) grant number 2012027176 . Funding Information: Dr. James K. Min receives funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare. Dr. Min serves on the scientific advisory board of Arineta and GE Healthcare, and has an equity interest in Cleerly. Dr. Gianluca Pontone is a member of the speakers’ bureau for GE Healthcare, Bracco, and Medtronic. He also conducts research for GE Healthcare and Heartflow. Dr. Matthew Budoff receives grant support from GE Healthcare and the NIH. All other authors have no relevant disclosures. Publisher Copyright: © 2019

PY - 2019/5/1

Y1 - 2019/5/1

N2 - The prognostic performance of coronary artery calcium score (CACS) for predicting adverse outcomes in patients with decreased renal function remains unclear. We aimed to examine whether CACS improves risk stratification by demonstrating incremental value beyond a traditional risk score according to renal function status. 9,563 individuals without known coronary artery disease were enrolled. Estimated glomerular filtration rate (eGFR, ml/min/1.73 m 2 ) was ascertained using the modified Modification of Diet in Renal Disease formula, and was categorized as: ≥90, 60 to 89, and <60. CACS was categorized as 0, 1 to 100, 101 to 400, and >400. Multivariable Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (95% CI) for major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, and late revascularization (>90 days). Mean age was 55.8 ± 11.5 years (52.8% male). In total, 261 (2.7%) patients experienced MACE over a median follow-up of 24.5 months (interquartile range: 16.9 to 41.1). Incident MACE increased with higher CACS across each eGFR category, with the highest rate observed among patients with CACS >400 and eGFR <60 (95.1 per 1,000 person-years). A CACS >400 increased MACE risk with HR 4.46 (95% CI 1.68 to 11.85), 6.63 (95% CI 4.03 to 10.92), and 6.14 (95% CI 2.85 to 13.21) for eGFR ≥90, 60 to 89, and <60, respectively, as compared with CACS 0. Further, CACS improved discrimination and reclassification beyond Framingham 10-year risk score (FRS) (AUC: 0.70 vs 0.64; category free-NRI: 0.51, all p <0.001) for predicting MACE in patients with impaired renal function (eGFR < 90). In conclusion, CACS improved risk stratification and provided incremental value beyond FRS for predicting MACE, irrespective of eGFR status.

AB - The prognostic performance of coronary artery calcium score (CACS) for predicting adverse outcomes in patients with decreased renal function remains unclear. We aimed to examine whether CACS improves risk stratification by demonstrating incremental value beyond a traditional risk score according to renal function status. 9,563 individuals without known coronary artery disease were enrolled. Estimated glomerular filtration rate (eGFR, ml/min/1.73 m 2 ) was ascertained using the modified Modification of Diet in Renal Disease formula, and was categorized as: ≥90, 60 to 89, and <60. CACS was categorized as 0, 1 to 100, 101 to 400, and >400. Multivariable Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (95% CI) for major adverse cardiac events (MACE), comprising all-cause mortality, myocardial infarction, and late revascularization (>90 days). Mean age was 55.8 ± 11.5 years (52.8% male). In total, 261 (2.7%) patients experienced MACE over a median follow-up of 24.5 months (interquartile range: 16.9 to 41.1). Incident MACE increased with higher CACS across each eGFR category, with the highest rate observed among patients with CACS >400 and eGFR <60 (95.1 per 1,000 person-years). A CACS >400 increased MACE risk with HR 4.46 (95% CI 1.68 to 11.85), 6.63 (95% CI 4.03 to 10.92), and 6.14 (95% CI 2.85 to 13.21) for eGFR ≥90, 60 to 89, and <60, respectively, as compared with CACS 0. Further, CACS improved discrimination and reclassification beyond Framingham 10-year risk score (FRS) (AUC: 0.70 vs 0.64; category free-NRI: 0.51, all p <0.001) for predicting MACE in patients with impaired renal function (eGFR < 90). In conclusion, CACS improved risk stratification and provided incremental value beyond FRS for predicting MACE, irrespective of eGFR status.

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Lee JH, Rizvi A, Hartaigh B, Han D, Park MW, Roudsari HM et al. The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry). American Journal of Cardiology. 2019 May 1;123(9):1435-1442. doi: 10.1016/j.amjcard.2019.01.055

The Predictive Value of Coronary Artery Calcium Scoring for Major Adverse Cardiac Events According to Renal Function (from the Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter [CONFIRM] Registry)

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