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, New York Presbyterian Hospital
Asim Rizvi, New York Presbyterian Hospital
Bríain Hartaigh, New York Presbyterian Hospital
Donghee Han, New York Presbyterian Hospital
Mahn Won Park, New York Presbyterian Hospital
Hadi Mirhedayati Roudsari, New York Presbyterian Hospital
Wijnand J. Stuijfzand, New York Presbyterian Hospital
Heidi Gransar, Cedars-Sinai Medical Center
Yao Lu, New York Presbyterian Hospital
Tracy Q. Callister, Tennessee Heart and Vascular Institute
Daniel S. Berman, Cedars-Sinai Medical Center
Augustin DeLago, Capitol Cardiology Associates
Martin Hadamitzky, Deutsches Herzzentrum München
Joerg Hausleiter, Ludwig-Maximilians-Universität München
Mouaz H. Al-Mallah, Methodist Hospital Houston
Matthew J. Budoff, The Lundquist Institute
Philipp A. Kaufmann, University of Zurich
Gilbert L. Raff, William Beaumont Hospital
Kavitha Chinnaiyan, William Beaumont Hospital
Filippo Cademartiri, IRCCS Fondazione SDN
Erica Maffei
Todd C. Villines, Walter Reed National Military Medical Center
Yong Jin Kim, Seoul National University Hospital
Jonathon Leipsic, The University of British Columbia
Gudrun Feuchtner, Medizinische Universitat Innsbruck
Gianluca Pontone, IRCCS Centro Cardiologico Monzino
Daniele Andreini, IRCCS Centro Cardiologico Monzino
Hugo Marques, Hospital da Luz
Pedro de Araújo Gonçalves, Hospital da Luz
Ronen Rubinshtein, Technion - Israel Institute of Technology
Stephan Achenbach, Friedrich-Alexander-Universität Erlangen-Nürnberg
Leslee J. Shaw, New York Presbyterian Hospital
Benjamin J.W. Chow, University of Ottawa, Canada


© 2019 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.