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Predictive value of abdominal aortic calcification index for mid-term cardiovascular events in patients with acute coronary syndrome

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Abstract

The utility of abdominal aortic calcification (AAC) for prediction of cardiovascular events (CVEs) in patients with acute coronary syndrome (ACS) remains to be determined. The aim of this prospective study was to determine the predictive value of the abdominal aortic calcification index (ACI), a semi-quantitative measure of AAC, for CVEs in patients with ACS. We evaluated 314 patients with ACS. All patients underwent successful percutaneous coronary intervention to the culprit coronary vessel without in-hospital adverse events. ACI was calculated on non-contrast computed tomography images. CVEs were defined as a composite of cardiovascular death, ACS recurrence, and stroke. During a median follow-up period of 19.1 months, CVEs occurred in 29 patients (9.2%). Multivariable regression analysis after adjustment for age and gender showed a significantly higher baseline ACI in patients with CVEs than in those without [median (interquartile ranges), 42.1 (25.9–60.2) vs. 20.8 (8.8–38.6) %; P = 0.021]. The cutoff value of ACI for prediction of CVEs, estimated by receiver-operating characteristic analysis, was 29.2%, with sensitivity of 76% and specificity of 64% (area under the curve, 0.69). After adjustment for conventional cardiovascular risk factors, Cox analysis showed high ACI (≥29.2%) to be significantly associated with increased risk of CVEs (P = 0.011; hazard ratio, 1.82). Multivariate analysis identified high ACI as an independent predictor of CVEs (P = 0.012; hazard ratio, 1.80). Stepwise forward selection procedure also showed that high ACI was a significant independent determinant of CVEs (P = 0.004; R2, 0.089). Both net reclassification improvement (0.64; P = 0.001) and integrated discrimination improvement (0.04; P < 0.001) improved significantly after the addition of high ACI to conventional risk factors. Evaluation of ACI using CT seems to provide valuable clinical information for proper assessment of mid-term CVEs in patients with ACS after percutaneous coronary intervention.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-cho, Tajimi, 507-8522, Japan

    Hideo Oishi, Hideki Horibe, Yuichiro Yamase, Chikara Ueyama, Yoshio Takemoto, Toshimasa Shigeta, Takeshi Hibino & Taizo Kondo

  2. Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Hideo Oishi, Susumu Suzuki, Hideki Ishii & Toyoaki Murohara

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Supplemental Figure 1.

Flow diagram of the patient recruitment process applied in the present study. We screened 453 consecutive patients with ACS who underwent successful PCI to the culprit coronary vessel. Furthermore, 139 were excluded. Accordingly, a total of 314 patients were evaluated in this study. ACS, acute coronary syndrome; PCI, percutaneous coronary intervention (JPG 71 kb)

Supplemental Figure 2.

Receiver operating characteristic curve analysis of abdominal aortic calcification index for cardiovascular events. Cardiovascular events were defined as composite of cardiovascular death, recurrent acute coronary syndrome, and stroke. Area under the curve was 0.69 (95% confidence interval, 0.57-0.78). The cut-off value of ACI was 29.2% with sensitivity of 76% and specificity of 64%. ACI, abdominal aortic calcification index (JPG 57 kb)

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Oishi, H., Horibe, H., Yamase, Y. et al. Predictive value of abdominal aortic calcification index for mid-term cardiovascular events in patients with acute coronary syndrome. Heart Vessels 35, 620–629 (2020). https://doi.org/10.1007/s00380-019-01527-6

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