Circulation. Cardiovascular imaging · 2025
Novel CAC Dispersion and Density Score to Predict Myocardial Infarction and Cardiovascular Mortality.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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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 T V, Butler Craig R, Tandon Vikas, Nagele Peter, Woodard Pamela K, Mrkobrada Marko, Szczeklik Wojciech, Aziz Yang Faridah Abdul, Biccard Bruce, Devereaux Philip James, Sheth Tej, Dwivedi Girish, Chow Benjamin J W
Аннотация
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% men) 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.
METHODS: We conducted a multicenter, retrospective, cross-sectional study of 961 patients (median age, 67 years; 61% men) 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.