Novel CAC Dispersion and Density Score to Predict Myocardial Infarction and Cardiovascular Mortality. Journal Articles uri icon

  •  
  • Overview
  •  
  • Research
  •  
  • Identity
  •  
  • Additional Document Info
  •  
  • View All
  •  

abstract

  • BACKGROUND: Coronary artery calcification (CAC) provides robust prediction for major adverse cardiovascular events (MACE), but current techniques disregard plaque distribution and protective effects of high CAC density. We investigated whether a novel CAC-dispersion and density (CAC-DAD) score will exhibit superior prognostic value compared with the Agatston score (AS) for MACE prediction. METHODS: We conducted a multicenter, retrospective, cross-sectional study of 961 patients (median age, 67 years; 61% male) who underwent cardiac computed tomography for cardiovascular or perioperative risk assessment. Blinded analyzers applied deep learning algorithms to noncontrast scans to calculate the CAC-DAD score, which adjusts for the spatial distribution of CAC and assigns a protective weight factor for lesions with ≥1000 Hounsfield units. Associations were assessed using frailty regression. RESULTS: Over a median follow-up of 30 (30-460) days, 61 patients experienced MACE (nonfatal myocardial infarction or cardiovascular mortality). An elevated CAC-DAD score (≥2050 based on optimal cutoff) captured more MACE than AS ≥400 (74% versus 57%; P=0.002). Univariable analysis revealed that an elevated CAC-DAD score, AS ≥400 and AS ≥100, age, diabetes, hypertension, and statin use predicted MACE. On multivariable analysis, only the CAC-DAD score (hazard ratio, 2.57 [95% CI, 1.43-4.61]; P=0.002), age, statins, and diabetes remained significant. The inclusion of the CAC-DAD score in a predictive model containing demographic factors and AS improved the C statistic from 0.61 to 0.66 (P=0.008). CONCLUSIONS: The fully automated CAC-DAD score improves MACE prediction compared with the AS. Patients with a high CAC-DAD score, including those with a low AS, may be at higher risk and warrant intensification of their preventative therapies.

authors

  • Huangfu, Gavin
  • Ihdayhid, Abdul R
  • Kwok, Simon
  • Konstantopoulos, John
  • Niu, Kai
  • Lu, Juan
  • Smallbone, Harry
  • Figtree, Gemma A
  • Chow, Clara K
  • Dembo, Lawrence
  • Adler, Brendan
  • Hamilton-Craig, Christian
  • Grieve, Stuart M
  • Chan, Matthew TV
  • Butler, Craig
  • Tandon, Vikas
  • Nagele, Peter
  • Woodard, Pamela K
  • Mrkobrada, Marko
  • Szczeklik, Wojciech
  • Aziz, Yang Faridah Abdul
  • Biccard, Bruce
  • Devereaux, Philip
  • Sheth, Tej
  • Dwivedi, Girish
  • Chow, Benjamin JW

publication date

  • July 4, 2025