Huangfu, Gavin and Ihdayhid, Abdul R. and Kwok, Simon and Konstantopoulos, John and Niu, Kai and Lu, Juan and Smallbone, Harry and Figtree, Gemma A. and Chow, Clara K. and Dembo, Lawrence and Adler, Brendan and Hamilton-Craig, Christian and Grieve, Stuart M. and Chan, Matthew T.V. and Butler, Craig R. and Tandon, Vikas and Nagele, Peter and Woodard, Pamela K. and Mrkobrada, Marko and Szczeklik, Wojciech and Aziz, Yang Faridah Abdul and Biccard, Bruce and Devereaux, Philip James and Sheth, Tej and Dwivedi, Girish and Chow, Benjamin J.W. (2025) Novel CAC Dispersion and Density Score to Predict Myocardial Infarction and Cardiovascular Mortality. Circulation: Cardiovascular Imaging, 18 (8). ISSN 1941-9651
Full text not available from this repository.Abstract
BACKGROUND:
Coronary artery calcification (CAC) provides robust prediction for major adverse cardiovascular events (MACE), but current techniques disregard plaque distribution and protective effects of high CAC density. We investigated whether a novel CAC-dispersion and density (CAC-DAD) score will exhibit superior prognostic value compared with the Agatston score (AS) for MACE prediction.
METHODS:
We conducted a multicenter, retrospective, cross-sectional study of 961 patients (median age, 67 years; 61% men) who underwent cardiac computed tomography for cardiovascular or perioperative risk assessment. Blinded analyzers applied deep learning algorithms to noncontrast scans to calculate the CAC-DAD score, which adjusts for the spatial distribution of CAC and assigns a protective weight factor for lesions with ≥1000 Hounsfield units. Associations were assessed using frailty regression.
RESULTS:
Over a median follow-up of 30 (30–460) days, 61 patients experienced MACE (nonfatal myocardial infarction or cardiovascular mortality). An elevated CAC-DAD score (≥2050 based on optimal cutoff) captured more MACE than AS ≥400 (74% versus 57%; P =0.002). Univariable analysis revealed that an elevated CAC-DAD score, AS ≥400 and AS ≥100, age, diabetes, hypertension, and statin use predicted MACE. On multivariable analysis, only the CAC-DAD score (hazard ratio, 2.57 [95% CI, 1.43–4.61]; P =0.002), age, statins, and diabetes remained significant. The inclusion of the CAC-DAD score in a predictive model containing demographic factors and AS improved the C statistic from 0.61 to 0.66 ( P =0.008).
CONCLUSIONS:
The fully automated CAC-DAD score improves MACE prediction compared with the AS. Patients with a high CAC-DAD score, including those with a low AS, may be at higher risk and warrant intensification of their preventative therapies.
| Item Type: | Article |
|---|---|
| Subjects: | R Medicine > R Medicine (General) |
| Depositing User: | Repository Administrator |
| Date Deposited: | 04 Dec 2025 03:59 |
| Last Modified: | 04 Dec 2025 03:59 |
| URI: | http://eprints.victorchang.edu.au/id/eprint/1750 |
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