Comparison of ordinal versus Agatston coronary calcification scoring for cardiovascular disease mortality in community-living individuals

  • Katherine J. Blair
  • Matthew A. Allison
  • Cindy Morgan
  • Christina L. Wassel
  • Dena E. Rifkin
  • C. Michael Wright
  • Michael H. Criqui
  • Joachim H. Ix
Original Paper

Abstract

Coronary artery calcification (CAC) by the Agatston method predicts cardiovascular disease (CVD), but requires cardiac gated computed tomography (CT) scans, a procedure not covered by most insurance providers. An ordinal CAC score (scored 0–12 based on artery number and extent of calcification involvement) can be measured on standard chest CTs. However, the correlation of ordinal and Agatston CAC scores and their relative association with CVD mortality is uncertain, which we sought to determine. Nested case–control study. Community-living individuals undergoing “whole body” CT scans for preventive medicine. 4,544 consecutive patients with CT scans, were followed from 2000 to 2009. We selected cases who died of CVD (n = 57) and age, sex, and CT slice-thickness matched each case to three controls (N = 171). Cardiac gated 3 mm chest CTs and non-gated 6 mm standard chest CTs. CVD death over 9 years follow-up. The intra- and inter-reader kappa for the ordinal CAC score was 0.90 and 0.76 respectively. The correlation of Agatston and ordinal CAC scores was 0.72 (p < 0.001). In models adjusted for traditional CVD risk factors, the odds of CVD death per 1 SD greater CAC was 1.66 (1.03–2.68) using the ordinal CAC score and 1.57 (1.00–2.46) using the Agatston score. A simple ordinal CAC score is reproducible, strongly correlated with Agatston CAC scores, and provides similar prediction for CVD death in predominantly Caucasian community-living individuals.

Keywords

Calcium Cardiovascular diseases Circulation Imaging Epidemiology 

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Copyright information

© Springer Science+Business Media B.V. (outside the USA)  2014

Authors and Affiliations

  • Katherine J. Blair
    • 1
  • Matthew A. Allison
    • 1
    • 2
    • 5
  • Cindy Morgan
    • 2
  • Christina L. Wassel
    • 1
    • 2
  • Dena E. Rifkin
    • 1
    • 2
    • 3
    • 5
  • C. Michael Wright
    • 2
  • Michael H. Criqui
    • 1
    • 2
    • 4
  • Joachim H. Ix
    • 1
    • 2
    • 3
    • 5
    • 6
  1. 1.University of California, San Diego, School of MedicineLa JollaUSA
  2. 2.Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California, San DiegoSchool of MedicineLa JollaUSA
  3. 3.Division of Nephrology, Department of MedicineUniversity of California, San Diego, School of MedicineLa JollaUSA
  4. 4.Department of Medicine, Division of CardiologyUniversity of California, San Diego, School of MedicineLa JollaUSA
  5. 5.Veterans Affairs San Diego Healthcare SystemSan DiegoUSA
  6. 6.Division of Nephrology and Hypertension, Department of MedicineUniversity of California San Diego, and San Diego VA Healthcare SystemSan DiegoUSA

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