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

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.

Coronary artery disease. 2021;(4):317-328
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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.

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Publication Type : Meta-Analysis

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