Coronary artery calcium score and risk of cardiovascular events without established coronary artery disease: a systemic review and meta-analysis.

Ahmed Abuzaid, Marwan Saad, Antoine Addoumieh, Le Dung Ha, Ayman Elbadawi, Ahmed N Mahmoud, Akram Elgendy, Hesham K Abdelaziz, Amr F Barakat, Amgad Mentias, Oluwaseun Adeola, Islam Y Elgendy, Atif Qasim, Matthew Budoff

Journal: Coronary artery disease 2022;32(4):317-328

PMID: 33417339

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Abstract

BACKGROUND

Coronary artery calcium (CAC) is an indicator of atherosclerosis, and the CAC score is a useful noninvasive assessment of coronary artery disease.

OBJECTIVE

To compare the risk of cardiovascular outcomes in patients with CAC > 0 versus CAC = 0 in asymptomatic and symptomatic population in patients without an established diagnosis of coronary artery disease.

METHODS

A systematic search of electronic databases was conducted until January 2018 for any cohort study reporting cardiovascular events in patients with CAC > 0 compared with absence of CAC.

RESULTS

Forty-five studies were included with 192 080 asymptomatic 32 477 symptomatic patients. At mean follow-up of 11 years, CAC > 0 was associated with an increased risk of major adverse cardiovascular and cerebrovascular events (MACE) compared to a CAC = 0 in asymptomatic arm [pooled risk ratio (RR) 4.05, 95% confidence interval (CI) 2.91-5.63, P < 0.00001, I2 = 80%] and symptomatic arm (pooled RR 6.06, 95% CI 4.23-8.68, P < 0.00001, I2 = 69%). CAC > 0 was also associated with increased risk of all-cause mortality in symptomatic population (pooled RR 7.94, 95% CI 2.61-24.17, P < 0.00001, I2 = 85%) and in asymptomatic population CAC > 0 was associated with higher all-cause mortality (pooled RR 3.23, 95% CI 2.12-4.93, P < 0.00001, I2 = 94%). In symptomatic population, revascularization in CAC > 0 was higher (pooled RR 15, 95% CI 6.66-33.80, P < 0.00001, I2 = 72) compared with CAC = 0. Additionally, CAC > 0 was associated with more revascularization in asymptomatic population (pooled RR 5.34, 95% CI 2.06-13.85, P = 0.0006, I2 = 93). In subgroup analysis of asymptomatic population by gender, CAC > 0 was associated with higher MACE (RR 6.39, 95% CI 3.39-12.84, P < 0.00001).

CONCLUSION

Absence of CAC is associated with low risk of cardiovascular events compared with any CAC > 0 in both asymptomatic and symptomatic population without coronary artery disease.

Address: Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California.; Department of Cardiology, Alaska Heart and Vascular Institute, Anchorage, Alaska, USA.; Department of Cardiology, Ain Shams University, Cairo, Egypt.; Department of Cardiology, Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island.; University of Texas, Health Science Center at Houston.; Departement of Cardiology, New York Presbyterian - Brooklyn Methodist Hospital, New York.; Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas.; Cardiovascular Department, University Hospitals, Case Western, Ohio.; Department of Cardiology, Lancashire Cardiac Center, Blackpool, UK.; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; Department of cardiology, Cleveland Clinic Foundation, Cleveland, Ohio.; Division of Cardiovascular Medicine, Vanderbilt, Nashville, Tennessee.; Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.; Lundquist Institute at Harbor-UCLA Medical Center, Torrance CA.

DOI: 10.1097/MCA.0000000000000974

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MeSH Terms: Cardiovascular Diseases, Coronary Angiography, Coronary Vessels, Humans, Myocardial Infarction, Myocardial Revascularization, Risk Assessment, Vascular Calcification