Baseline subclinical atherosclerosis burden and distribution are associated with frequency and mode of future coronary revascularization

Multi-ethnic study of atherosclerosis

Michael G. Silverman, James R. Harkness, Ron Blankstein, Matthew J. Budoff, Arthur S. Agatston, J. Jeffrey Carr, Joao A. Lima, Roger S. Blumenthal, Khurram Nasir, Michael J. Blaha

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Objectives The aim of this study was to evaluate the impact of coronary artery calcium (CAC) burden and regional distribution on the need for and type of future coronary revascularization - percutaneous versus surgical (coronary artery bypass graft [CABG]) - among asymptomatic subjects. Background The need for coronary revascularization and the chosen mode of revascularization are thought to be functions of disease burden and anatomic distribution. The association between the baseline burden and regional distribution of CAC and the risk and type of future coronary revascularization remains unknown. Methods A total of 6,540 participants in the MESA (Multi-Ethnic Study of Atherosclerosis) (subjects aged 45 to 84 years, free of known baseline cardiovascular disease) with vessel-specific CAC measurements were followed for a median of 8.5 years (interquartile range: 7.7 to 8.6 years). Annualized rates and multivariate-adjusted hazard ratios for revascularization and revascularization type were analyzed according to CAC score category, number of vessels with CAC (0 to 4, including the left main coronary artery), and involvement of individual coronary arteries. Results A total of 265 revascularizations (4.2%) occurred during follow-up, and 206 (78% of the total) were preceded by adjudicated symptoms. Revascularization was uncommon when CAC score was 0.0 (0.6%), with a graded increase over both rising CAC burden and increasingly diffuse CAC distribution. The revascularization rates per 1,000 person-years for CAC scores of 1 to 100, 101 to 400, and >400 were 4.9, 11.7, and 25.4, respectively; for 1, 2, 3, and 4 vessels with CAC, the rates were 3.0, 8.0, 16.1, and 24.8, respectively. In multivariate models adjusting for CAC score, the number of vessels with CAC remained predictive of revascularization and mode of revascularization. Independent predictors of CABG versus percutaneous coronary intervention included 3- or 4-vessel CAC, higher CAC burden, and involvement of the left main coronary artery. Risk for CABG was extremely low with <3-vessel baseline CAC. Results were similar when considering only symptom-driven revascularizations. Conclusions In this multiethnic cohort of asymptomatic subjects, baseline CAC was highly predictive of future coronary revascularization procedures, with measures of CAC burden and distribution each independently predicting need for percutaneous coronary intervention versus CABG over an 8.5-year follow-up.

Original languageEnglish
Pages (from-to)476-486
Number of pages11
JournalJACC: Cardiovascular Imaging
Volume7
Issue number5
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Atherosclerosis
Coronary Vessels
Calcium
Coronary Artery Bypass
Percutaneous Coronary Intervention
Transplants

Keywords

  • cardiac CT
  • coronary artery calcium
  • coronary artery disease
  • revascularization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Baseline subclinical atherosclerosis burden and distribution are associated with frequency and mode of future coronary revascularization : Multi-ethnic study of atherosclerosis. / Silverman, Michael G.; Harkness, James R.; Blankstein, Ron; Budoff, Matthew J.; Agatston, Arthur S.; Carr, J. Jeffrey; Lima, Joao A.; Blumenthal, Roger S.; Nasir, Khurram; Blaha, Michael J.

In: JACC: Cardiovascular Imaging, Vol. 7, No. 5, 01.01.2014, p. 476-486.

Research output: Contribution to journalArticle

Silverman, MG, Harkness, JR, Blankstein, R, Budoff, MJ, Agatston, AS, Carr, JJ, Lima, JA, Blumenthal, RS, Nasir, K & Blaha, MJ 2014, 'Baseline subclinical atherosclerosis burden and distribution are associated with frequency and mode of future coronary revascularization: Multi-ethnic study of atherosclerosis', JACC: Cardiovascular Imaging, vol. 7, no. 5, pp. 476-486. https://doi.org/10.1016/j.jcmg.2014.03.005
Silverman, Michael G. ; Harkness, James R. ; Blankstein, Ron ; Budoff, Matthew J. ; Agatston, Arthur S. ; Carr, J. Jeffrey ; Lima, Joao A. ; Blumenthal, Roger S. ; Nasir, Khurram ; Blaha, Michael J. / Baseline subclinical atherosclerosis burden and distribution are associated with frequency and mode of future coronary revascularization : Multi-ethnic study of atherosclerosis. In: JACC: Cardiovascular Imaging. 2014 ; Vol. 7, No. 5. pp. 476-486.
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title = "Baseline subclinical atherosclerosis burden and distribution are associated with frequency and mode of future coronary revascularization: Multi-ethnic study of atherosclerosis",
abstract = "Objectives The aim of this study was to evaluate the impact of coronary artery calcium (CAC) burden and regional distribution on the need for and type of future coronary revascularization - percutaneous versus surgical (coronary artery bypass graft [CABG]) - among asymptomatic subjects. Background The need for coronary revascularization and the chosen mode of revascularization are thought to be functions of disease burden and anatomic distribution. The association between the baseline burden and regional distribution of CAC and the risk and type of future coronary revascularization remains unknown. Methods A total of 6,540 participants in the MESA (Multi-Ethnic Study of Atherosclerosis) (subjects aged 45 to 84 years, free of known baseline cardiovascular disease) with vessel-specific CAC measurements were followed for a median of 8.5 years (interquartile range: 7.7 to 8.6 years). Annualized rates and multivariate-adjusted hazard ratios for revascularization and revascularization type were analyzed according to CAC score category, number of vessels with CAC (0 to 4, including the left main coronary artery), and involvement of individual coronary arteries. Results A total of 265 revascularizations (4.2{\%}) occurred during follow-up, and 206 (78{\%} of the total) were preceded by adjudicated symptoms. Revascularization was uncommon when CAC score was 0.0 (0.6{\%}), with a graded increase over both rising CAC burden and increasingly diffuse CAC distribution. The revascularization rates per 1,000 person-years for CAC scores of 1 to 100, 101 to 400, and >400 were 4.9, 11.7, and 25.4, respectively; for 1, 2, 3, and 4 vessels with CAC, the rates were 3.0, 8.0, 16.1, and 24.8, respectively. In multivariate models adjusting for CAC score, the number of vessels with CAC remained predictive of revascularization and mode of revascularization. Independent predictors of CABG versus percutaneous coronary intervention included 3- or 4-vessel CAC, higher CAC burden, and involvement of the left main coronary artery. Risk for CABG was extremely low with <3-vessel baseline CAC. Results were similar when considering only symptom-driven revascularizations. Conclusions In this multiethnic cohort of asymptomatic subjects, baseline CAC was highly predictive of future coronary revascularization procedures, with measures of CAC burden and distribution each independently predicting need for percutaneous coronary intervention versus CABG over an 8.5-year follow-up.",
keywords = "cardiac CT, coronary artery calcium, coronary artery disease, revascularization",
author = "Silverman, {Michael G.} and Harkness, {James R.} and Ron Blankstein and Budoff, {Matthew J.} and Agatston, {Arthur S.} and Carr, {J. Jeffrey} and Lima, {Joao A.} and Blumenthal, {Roger S.} and Khurram Nasir and Blaha, {Michael J.}",
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TY - JOUR

T1 - Baseline subclinical atherosclerosis burden and distribution are associated with frequency and mode of future coronary revascularization

T2 - Multi-ethnic study of atherosclerosis

AU - Silverman, Michael G.

AU - Harkness, James R.

AU - Blankstein, Ron

AU - Budoff, Matthew J.

AU - Agatston, Arthur S.

AU - Carr, J. Jeffrey

AU - Lima, Joao A.

AU - Blumenthal, Roger S.

AU - Nasir, Khurram

AU - Blaha, Michael J.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Objectives The aim of this study was to evaluate the impact of coronary artery calcium (CAC) burden and regional distribution on the need for and type of future coronary revascularization - percutaneous versus surgical (coronary artery bypass graft [CABG]) - among asymptomatic subjects. Background The need for coronary revascularization and the chosen mode of revascularization are thought to be functions of disease burden and anatomic distribution. The association between the baseline burden and regional distribution of CAC and the risk and type of future coronary revascularization remains unknown. Methods A total of 6,540 participants in the MESA (Multi-Ethnic Study of Atherosclerosis) (subjects aged 45 to 84 years, free of known baseline cardiovascular disease) with vessel-specific CAC measurements were followed for a median of 8.5 years (interquartile range: 7.7 to 8.6 years). Annualized rates and multivariate-adjusted hazard ratios for revascularization and revascularization type were analyzed according to CAC score category, number of vessels with CAC (0 to 4, including the left main coronary artery), and involvement of individual coronary arteries. Results A total of 265 revascularizations (4.2%) occurred during follow-up, and 206 (78% of the total) were preceded by adjudicated symptoms. Revascularization was uncommon when CAC score was 0.0 (0.6%), with a graded increase over both rising CAC burden and increasingly diffuse CAC distribution. The revascularization rates per 1,000 person-years for CAC scores of 1 to 100, 101 to 400, and >400 were 4.9, 11.7, and 25.4, respectively; for 1, 2, 3, and 4 vessels with CAC, the rates were 3.0, 8.0, 16.1, and 24.8, respectively. In multivariate models adjusting for CAC score, the number of vessels with CAC remained predictive of revascularization and mode of revascularization. Independent predictors of CABG versus percutaneous coronary intervention included 3- or 4-vessel CAC, higher CAC burden, and involvement of the left main coronary artery. Risk for CABG was extremely low with <3-vessel baseline CAC. Results were similar when considering only symptom-driven revascularizations. Conclusions In this multiethnic cohort of asymptomatic subjects, baseline CAC was highly predictive of future coronary revascularization procedures, with measures of CAC burden and distribution each independently predicting need for percutaneous coronary intervention versus CABG over an 8.5-year follow-up.

AB - Objectives The aim of this study was to evaluate the impact of coronary artery calcium (CAC) burden and regional distribution on the need for and type of future coronary revascularization - percutaneous versus surgical (coronary artery bypass graft [CABG]) - among asymptomatic subjects. Background The need for coronary revascularization and the chosen mode of revascularization are thought to be functions of disease burden and anatomic distribution. The association between the baseline burden and regional distribution of CAC and the risk and type of future coronary revascularization remains unknown. Methods A total of 6,540 participants in the MESA (Multi-Ethnic Study of Atherosclerosis) (subjects aged 45 to 84 years, free of known baseline cardiovascular disease) with vessel-specific CAC measurements were followed for a median of 8.5 years (interquartile range: 7.7 to 8.6 years). Annualized rates and multivariate-adjusted hazard ratios for revascularization and revascularization type were analyzed according to CAC score category, number of vessels with CAC (0 to 4, including the left main coronary artery), and involvement of individual coronary arteries. Results A total of 265 revascularizations (4.2%) occurred during follow-up, and 206 (78% of the total) were preceded by adjudicated symptoms. Revascularization was uncommon when CAC score was 0.0 (0.6%), with a graded increase over both rising CAC burden and increasingly diffuse CAC distribution. The revascularization rates per 1,000 person-years for CAC scores of 1 to 100, 101 to 400, and >400 were 4.9, 11.7, and 25.4, respectively; for 1, 2, 3, and 4 vessels with CAC, the rates were 3.0, 8.0, 16.1, and 24.8, respectively. In multivariate models adjusting for CAC score, the number of vessels with CAC remained predictive of revascularization and mode of revascularization. Independent predictors of CABG versus percutaneous coronary intervention included 3- or 4-vessel CAC, higher CAC burden, and involvement of the left main coronary artery. Risk for CABG was extremely low with <3-vessel baseline CAC. Results were similar when considering only symptom-driven revascularizations. Conclusions In this multiethnic cohort of asymptomatic subjects, baseline CAC was highly predictive of future coronary revascularization procedures, with measures of CAC burden and distribution each independently predicting need for percutaneous coronary intervention versus CABG over an 8.5-year follow-up.

KW - cardiac CT

KW - coronary artery calcium

KW - coronary artery disease

KW - revascularization

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