title: A 15-Year Warranty Period for Asymptomatic Individuals Without Coronary Artery Calcium: A Prospective Follow-Up of 9,715 Individuals.
abstract: OBJECTIVE
  The aim of this study was to examine the long-term prognosis in asymptomatic individuals with a coronary artery calcium (CAC) score of 0 and its associated warranty period.
  
  
  BACKGROUND
  Emerging evidence supports a CAC score of 0 as a favorable cardiovascular short-to intermediate-term prognostic factor.
  
  
  METHODS
  A total of 9,715 individuals undergoing CAC imaging were stratified by age, Framingham risk score (FRS), and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) categories and followed for a mean of 14.6 years (range 12.9 to 16.8 years). Cox regression, area under the receiver-operating characteristic curve, and net reclassification information were used to assess all-cause mortality, discrimination, and reclassification of a CAC score of 0 compared with the FRS and NCEP ATP III, respectively. A warranty period was pre-defined as <1% annual mortality rate. Vascular age was estimated by linear regression.
  
  
  RESULTS
  In 4,864 individuals with a baseline CAC score of 0 (mean age, 52.1 ± 10.8 years; 57.9% male), 229 deaths occurred. The warranty period of a CAC score of 0 was almost 15 years for individuals at low and intermediate risk with no significant differences regarding age and sex. A CAC score of 0 was associated with a vascular age of 1, 10, 20, and 30 years less than the chronological age of individuals between 50 and 59, 60 and 69, 70 and 79, and 80 years of age and older, respectively. The CAC score was the strongest predictor of death (hazard ratio: 2.67, 95% confidence interval: 2.29 to 3.11) that enabled discrimination and consistent reclassification beyond the FRS (area under the receiver-operating characteristic curve: 0.71 vs. 0.64, p < 0.001) and NCEP ATP III (area under the receiver-operating characteristic curve: 0.72 vs. 0.64, p < 0.001).
  
  
  CONCLUSIONS
  A CAC score of 0 confers a 15-year warranty period against mortality in individuals at low to intermediate risk that is unaffected by age or sex. Furthermore, in individuals considered at high risk by clinical risk scores, a CAC score of 0 confers better survival than in individuals at low to intermediate risk but with any CAC score.
authors.affiliation: Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York.
authors.forename: Valentina
authors.initials: V
authors.lastname: Valenti
authors.affiliation: Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York; Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Bríain
authors.initials: B
authors.lastname: Ó Hartaigh
authors.affiliation: Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York.
authors.forename: Ran
authors.initials: R
authors.lastname: Heo
authors.affiliation: Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York.
authors.forename: Iksung
authors.initials: I
authors.lastname: Cho
authors.affiliation: Division of Cardiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York.
authors.forename: Joshua
authors.initials: J
authors.lastname: Schulman-Marcus
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Heidi
authors.initials: H
authors.lastname: Gransar
authors.affiliation: Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York.
authors.forename: Quynh A
authors.initials: QA
authors.lastname: Truong
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Joseph
authors.initials: J
authors.lastname: Knapper
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Anita A
authors.initials: AA
authors.lastname: Kelkar
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Pratik
authors.initials: P
authors.lastname: Sandesara
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Fay Y
authors.initials: FY
authors.lastname: Lin
authors.affiliation: IRCCS Neuromed, Pozzilli, Italy; Department of Medical-Surgical Sciences and Biotechnologies, University of Rome "Sapienza," Latina, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Sciarretta
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
authors.forename: Hyuk-Jae
authors.initials: HJ
authors.lastname: Chang
authors.affiliation: Tennessee Heart and Vascular Institute, Hendersonville, Tennessee.
authors.forename: Tracy Q
authors.initials: TQ
authors.lastname: Callister
authors.affiliation: Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York. Electronic address: jkm2001@med.cornell.edu.
authors.forename: James K
authors.initials: JK
authors.lastname: Min
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002118:Calcium / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000401:mortality*; D003331:Coronary Vessels / Q000737:chemistry*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012044:Regression Analysis; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D002118:Calcium
keywords: computed tomography; coronary artery calcium; mortality; prognosis; warranty period