title: Association of Coronary Artery Calcification and Mortality in the National Lung Screening Trial: A Comparison of Three Scoring Methods.
abstract: OBJECTIVE
  To evaluate three coronary artery calcification (CAC) scoring methods to assess risk of coronary heart disease (CHD) death and all-cause mortality in National Lung Screening Trial (NLST) participants across levels of CAC scores.
  
  
  METHODS
  The NLST was approved by the institutional review board at each participating institution, and informed consent was obtained from all participants. Image review was HIPAA compliant. Five cardiothoracic radiologists evaluated 1575 low-dose computed tomographic (CT) scans from three groups: 210 CHD deaths, 315 deaths not from CHD, and 1050 participants who were alive at conclusion of the trial. Radiologists used three scoring methods: overall visual assessment, segmented vessel-specific scoring, and Agatston scoring. Weighted Cox proportional hazards models were fit to evaluate the association between scoring methods and outcomes.
  
  
  RESULTS
  In multivariate analysis of time to CHD death, Agatston scores of 1-100, 101-1000, and greater than 1000 (reference category 0) were associated with hazard ratios of 1.27 (95% confidence interval: 0.69, 2.53), 3.57 (95% confidence interval: 2.14, 7.48), and 6.63 (95% confidence interval: 3.57, 14.97), respectively; hazard ratios for summed segmented vessel-specific scores of 1-5, 6-11, and 12-30 (reference category 0) were 1.72 (95% confidence interval: 1.05, 3.34), 5.11 (95% confidence interval: 2.92, 10.94), and 6.10 (95% confidence interval: 3.19, 14.05), respectively; and hazard ratios for overall visual assessment of mild, moderate, or heavy (reference category none) were 2.09 (95% confidence interval: 1.30, 4.16), 3.86 (95% confidence interval: 2.02, 8.20), and 6.95 (95% confidence interval: 3.73, 15.67), respectively.
  
  
  CONCLUSIONS
  By using low-dose CT performed for lung cancer screening in older, heavy smokers, a simple visual assessment of CAC can be generated for risk assessment of CHD death and all-cause mortality, which is comparable to Agatston scoring and strongly associated with outcome.
authors.affiliation: From the Department of Radiology, Wake Forest University Health Sciences Center, Medical Center Boulevard, Winston-Salem, NC 27157 (C.C.); Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI (F.D., B.S.S., S.D.); Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.W.G.); Department of Radiology, Medical University of South Carolina, Charleston, SC (J.G.R.); Summit Radiology LLC, Oconomowoc, Wis (S.G.B.); American College of Radiology Imaging Network, Philadelphia, Pa (S.S.D.); and Department of Radiology, Houston Methodist Hospital and Research Institute, Houston, Tex (R.F.M.).
authors.forename: Caroline
authors.initials: C
authors.lastname: Chiles
authors.affiliation: From the Department of Radiology, Wake Forest University Health Sciences Center, Medical Center Boulevard, Winston-Salem, NC 27157 (C.C.); Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI (F.D., B.S.S., S.D.); Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.W.G.); Department of Radiology, Medical University of South Carolina, Charleston, SC (J.G.R.); Summit Radiology LLC, Oconomowoc, Wis (S.G.B.); American College of Radiology Imaging Network, Philadelphia, Pa (S.S.D.); and Department of Radiology, Houston Methodist Hospital and Research Institute, Houston, Tex (R.F.M.).
authors.forename: Fenghai
authors.initials: F
authors.lastname: Duan
authors.affiliation: From the Department of Radiology, Wake Forest University Health Sciences Center, Medical Center Boulevard, Winston-Salem, NC 27157 (C.C.); Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI (F.D., B.S.S., S.D.); Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.W.G.); Department of Radiology, Medical University of South Carolina, Charleston, SC (J.G.R.); Summit Radiology LLC, Oconomowoc, Wis (S.G.B.); American College of Radiology Imaging Network, Philadelphia, Pa (S.S.D.); and Department of Radiology, Houston Methodist Hospital and Research Institute, Houston, Tex (R.F.M.).
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Gladish
authors.affiliation: From the Department of Radiology, Wake Forest University Health Sciences Center, Medical Center Boulevard, Winston-Salem, NC 27157 (C.C.); Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI (F.D., B.S.S., S.D.); Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.W.G.); Department of Radiology, Medical University of South Carolina, Charleston, SC (J.G.R.); Summit Radiology LLC, Oconomowoc, Wis (S.G.B.); American College of Radiology Imaging Network, Philadelphia, Pa (S.S.D.); and Department of Radiology, Houston Methodist Hospital and Research Institute, Houston, Tex (R.F.M.).
authors.forename: James G
authors.initials: JG
authors.lastname: Ravenel
authors.affiliation: From the Department of Radiology, Wake Forest University Health Sciences Center, Medical Center Boulevard, Winston-Salem, NC 27157 (C.C.); Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI (F.D., B.S.S., S.D.); Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.W.G.); Department of Radiology, Medical University of South Carolina, Charleston, SC (J.G.R.); Summit Radiology LLC, Oconomowoc, Wis (S.G.B.); American College of Radiology Imaging Network, Philadelphia, Pa (S.S.D.); and Department of Radiology, Houston Methodist Hospital and Research Institute, Houston, Tex (R.F.M.).
authors.forename: Scott G
authors.initials: SG
authors.lastname: Baginski
authors.affiliation: From the Department of Radiology, Wake Forest University Health Sciences Center, Medical Center Boulevard, Winston-Salem, NC 27157 (C.C.); Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI (F.D., B.S.S., S.D.); Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.W.G.); Department of Radiology, Medical University of South Carolina, Charleston, SC (J.G.R.); Summit Radiology LLC, Oconomowoc, Wis (S.G.B.); American College of Radiology Imaging Network, Philadelphia, Pa (S.S.D.); and Department of Radiology, Houston Methodist Hospital and Research Institute, Houston, Tex (R.F.M.).
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Snyder
authors.affiliation: From the Department of Radiology, Wake Forest University Health Sciences Center, Medical Center Boulevard, Winston-Salem, NC 27157 (C.C.); Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI (F.D., B.S.S., S.D.); Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.W.G.); Department of Radiology, Medical University of South Carolina, Charleston, SC (J.G.R.); Summit Radiology LLC, Oconomowoc, Wis (S.G.B.); American College of Radiology Imaging Network, Philadelphia, Pa (S.S.D.); and Department of Radiology, Houston Methodist Hospital and Research Institute, Houston, Tex (R.F.M.).
authors.forename: Sarah
authors.initials: S
authors.lastname: DeMello
authors.affiliation: From the Department of Radiology, Wake Forest University Health Sciences Center, Medical Center Boulevard, Winston-Salem, NC 27157 (C.C.); Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI (F.D., B.S.S., S.D.); Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.W.G.); Department of Radiology, Medical University of South Carolina, Charleston, SC (J.G.R.); Summit Radiology LLC, Oconomowoc, Wis (S.G.B.); American College of Radiology Imaging Network, Philadelphia, Pa (S.S.D.); and Department of Radiology, Houston Methodist Hospital and Research Institute, Houston, Tex (R.F.M.).
authors.forename: Stephanie S
authors.initials: SS
authors.lastname: Desjardins
authors.affiliation: From the Department of Radiology, Wake Forest University Health Sciences Center, Medical Center Boulevard, Winston-Salem, NC 27157 (C.C.); Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI (F.D., B.S.S., S.D.); Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (G.W.G.); Department of Radiology, Medical University of South Carolina, Charleston, SC (J.G.R.); Summit Radiology LLC, Oconomowoc, Wis (S.G.B.); American College of Radiology Imaging Network, Philadelphia, Pa (S.S.D.); and Department of Radiology, Houston Methodist Hospital and Research Institute, Houston, Tex (R.F.M.).
authors.forename: Reginald F
authors.initials: RF
authors.lastname: Munden
mesh_terms: D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality*