title: Incremental benefit of coronary artery calcium score above traditional risk factors for all-cause mortality in asymptomatic Korean adults.
abstract: BACKGROUND
  Coronary artery calcium score (CACS) is a well-recognized marker for subclinical coronary atherosclerosis, particularly in asymptomatic populations. To date, however, the added prognostic benefit of CACS compared with traditional risk factors in an Asian population remains unknown. This study therefore investigated the benefit of CACS over traditional risk factors for all-cause mortality in a large multicenter registry of asymptomatic Korean adults.
  
  
  RESULTS
  A total of 34,386 individuals were retrospectively enrolled to participate in a general health examination. The Framingham 10-year risk score (FRS) was calculated according to the traditional risk stratification algorithm and CACS was calculated in log(CACS+1) for continuous data and categorized as 0, 1-100, 101-400 and >400. During a median follow-up of 4.9 years (IQR, 3.0-7.1), there were 303 all-cause deaths (0.9%). Following adjustment, CACS was independently associated with all-cause death (hazard ratio, 1.10; 95% confidence interval (CI): 1.05-1.17; P<0.001). Notably, CACS added further prognostic value above and beyond FRS (likelihood ratio, χ(2)=75.42, P<0.001; continuous net reclassification improvement=0.40, 95% CI: 0.29-0.51, P≤0.001; improving C-statistic from 0.64, 95% CI: 0.61-0.67 to 0.68, 95% CI: 0.64-0.71; ∆C=0.04, 95% CI: 0.01-0.06, P=0.002).
  
  
  CONCLUSIONS
  In an asymptomatic Korean population, CACS improved prediction of all-cause mortality over and above that of a conventional risk tool.
authors.affiliation: Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine.
authors.forename: Donghee
authors.initials: D
authors.lastname: Han
authors.forename: Bríain
authors.initials: B
authors.lastname: Ó Hartaigh
authors.forename: Heidi
authors.initials: H
authors.lastname: Gransar
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Yoon
authors.forename: Kwang-Joon
authors.initials: KJ
authors.lastname: Kim
authors.forename: Min-Kyoung
authors.initials: MK
authors.lastname: Kim
authors.forename: Su-Yeon
authors.initials: SY
authors.lastname: Choi
authors.forename: Jidong
authors.initials: J
authors.lastname: Sung
authors.forename: Hyuk-Jae
authors.initials: HJ
authors.lastname: Chang
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D061205:Vascular Calcification / Q000175:diagnosis / Q000401:mortality*