Calcium score, coronary artery disease extent and severity, and clinical outcomes among low Framingham risk patients with low vs high lifetime risk: Results from the CONFIRM registry
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Short-term risk scores, such as the Framingham risk score (FRS), frequently classify younger patients as low risk despite the presence of uncontrolled cardiovascular risk factors. Among patients with low FRS, estimation of lifetime risk is associated with significant differences in coronary arterial calcium scores (CACS); however, the relationship of lifetime risk to coronary atherosclerosis on coronary CT angiography (CCTA) and prognosis has not been studied.
Methods and Results
We evaluated asymptomatic 20-60-year-old patients without diabetes or known coronary artery disease (CAD) within an international CT registry who underwent ≥64-slice CCTA. Patients with low FRS (<10%) were stratified as low (<39%) or high (≥39%) lifetime CAD risk, and compared for the presence and severity of CAD and prognosis for death, myocardial infarction, and late coronary revascularization (>90 days post CCTA). 1,863 patients of mean age of 47 years were included, with 48% of the low FRS patients at high lifetime risk. Median follow-up was 2.0 years. Comparing low-to-high lifetime risk, respectively, the prevalence of any CAD was 32% vs 41% (P < .001) and ≥50% stenosis was 7.4% vs 9.6% (P = .09). For those with CAD, subjects at low vs high lifetime risk had lower CACS (median 12 [IQR 0-94] vs 38 [IQR 0.05-144], P = .02) and less purely calcified plaque, 35% vs 45% (P < .001). Prognosis did not differ due to low number of events.
Assessment of lifetime risk among patients at low FRS identified those with the increase in CAD prevalence and severity and a higher proportion of calcified plaque.
KeywordsCoronary artery disease computed tomography outcomes research
Dr Villines has received speaker’s honoraria from Boehringer-Ingelheim, Ingelheim, Germany. Dr Achenbach has received grant support from Siemens Healthcare, Erlangen, Germany, and Bayer Schering Pharma AG, Berlin, Germany. Dr Budoff has received speaker’s honoraria from GE Healthcare, Milwaukee, Wisconsin. Dr Cademartiri has received grant support from GE Healthcare and speaker’s honoraria from Bracco Diagnostics, Milan, Italy. Dr Callister is on the speaker’s bureau of GE Healthcare. Dr Chinnaiyan has received grant support from Bayer Pharma AG, Berlin, Germany, and Blue Cross Blue Shield Blue Care Michigan. Dr Chow has received research support from GE Healthcare; Pfizer, Inc., New York, New York; and AstraZeneca, Wilmington, Delaware. Dr Chow has received educational support from TeraRecon, Foster City, California. Dr Hausleiter has received research grant support from Siemens Healthcare. Dr Kaufmann has received research support from GE Healthcare and grant support from the Swiss National Science Foundation, Bern, Switzerland. Dr Maffei has received grant support from GE Healthcare and is a consultant for Servier, Neuilly-sur- Seine, France. Dr Raff has received grant support from Siemens Healthcare, Blue Cross Blue Shield Blue Care Michigan, and Bayer Pharma AG. Dr Min has received speaker’s honoraria and research support from and serves on the medical advisory board of GE Healthcare. The views expressed here are those of the investigators only and are not to be construed as those of the United States Department of the Army or Department of Defense.
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