title: Long-Term Prognosis After Coronary Artery Calcification Testing in Asymptomatic Patients: A Cohort Study.
abstract: BACKGROUND
  The extent of coronary artery calcification (CAC) and near-term adverse clinical outcomes are strongly related through 5 years of follow-up.
  
  
  OBJECTIVE
  To describe the ability of CAC scores to predict long-term mortality in persons without symptoms of coronary artery disease.
  
  
  METHODS
  Observational cohort.
  
  
  METHODS
  Single-center, outpatient cardiology laboratory.
  
  
  METHODS
  9715 asymptomatic patients.
  
  
  METHODS
  Coronary artery calcification scoring and binary risk factor data were collected. The primary end point was time to all-cause mortality (median follow-up, 14.6 years). Univariable and multivariable Cox proportional hazards models were used to compare survival distributions. The net reclassification improvement statistic was calculated.
  
  
  RESULTS
  In Cox models adjusted for risk factors for coronary artery disease, the CAC score was highly predictive of all-cause mortality (P < 0.001). Overall 15-year mortality rates ranged from 3% to 28% for CAC scores from 0 to 1000 or greater (P < 0.001). The relative hazard for all-cause mortality ranged from 1.68 for a CAC score of 1 to 10 (P < 0.001) to 6.26 for a score of 1000 or greater (P < 0.001). The categorical net reclassification improvement using cut points of less than 7.5% to 22.5% or greater was 0.21 (95% CI, 0.16 to 0.32).
  
  
  CONCLUSIONS
  Data collection was limited to a single center with generalizability limitations. Only binary risk factor data were available, and CAC was only measured once.
  
  
  CONCLUSIONS
  The extent of CAC accurately predicts 15-year mortality in a large cohort of asymptomatic patients. Long-term estimates of mortality provide a unique opportunity to examine the value of novel biomarkers, such as CAC, in estimating important patient outcomes.
  
  
  BACKGROUND
  None.
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Giambrone
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Knapper
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.forename: Naveen
authors.initials: N
authors.lastname: Bellam
authors.forename: Arshed
authors.initials: A
authors.lastname: Quyyumi
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.forename: Tracy Q
authors.initials: TQ
authors.lastname: Callister
authors.forename: James K
authors.initials: JK
authors.lastname: Min
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases / Q000401:mortality*; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011859:Radiography; D012307:Risk Factors