title: 15-Year prognostic utility of coronary artery calcium scoring for all-cause mortality in the elderly.
abstract: BACKGROUND
  Prior studies have demonstrated a decline in the predictive ability of conventional risk factors (RF) with advancing age, emphasizing the need for novel tools to improve risk stratification in the elderly. Coronary artery calcification (CAC) is a robust predictor of adverse cardiovascular events, but its long-term prognostic utility beyond RFs in elderly persons is unknown.
  
  
  METHODS
  A consecutive series of 9715 individuals underwent CAC scoring and were followed for a mean of 14.6 ± 1.1 years. Multivariable Cox proportional hazards regression (HR) with 95% confidence intervals (95% CI) was employed to assess the independent relationship of CAC and RFs with all-cause death. The incremental value of CAC, stratified by age, was examined by using an area under the receiver operator characteristic curve (AUC) and category-free net reclassification improvement (NRI).
  
  
  RESULTS
  Of the overall study sample, 728 (7.5%) adults (mean age 74.2 ± 4.2 years; 55.6% female) were 70 years or older, of which 157 (21.6%) died. The presence of any CAC was associated with a >4-fold (95% CI = 2.84-6.59) adjusted risk of death for those over the age of 70, which was higher compared with younger study counterparts, or other measured RFs. For individuals 70 years or older, the discriminatory ability of CAC improved upon that of RFs alone (C statistics 0.764 vs. 0.675, P < 0.001). CAC also enabled improved reclassification (category-free NRI = 84%, P < 0.001) when added to RFs.
  
  
  CONCLUSIONS
  In a large-scale observational cohort registry, CAC improves prediction, discrimination, and reclassification of elderly individuals at risk for future death.
authors: Department of Radiology and Medicine, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA.
authors: Bríain Ó
authors: BÓ
authors: Hartaigh
authors: Department of Radiology and Medicine, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA.
authors: Valentina
authors: V
authors: Valenti
authors: Department of Radiology and Medicine, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA.
authors: Iksung
authors: I
authors: Cho
authors: Department of Radiology and Medicine, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA.
authors: Joshua
authors: J
authors: Schulman-Marcus
authors: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors: Heidi
authors: H
authors: Gransar
authors: Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
authors: Joseph
authors: J
authors: Knapper
authors: Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
authors: Anita A
authors: AA
authors: Kelkar
authors: Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
authors: Joseph X
authors: JX
authors: Xie
authors: Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
authors: Hyuk-Jae
authors: HJ
authors: Chang
authors: Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
authors: Leslee J
authors: LJ
authors: Shaw
authors: Tennessee Heart and Vascular Institute, Hendersonville, TN, USA.
authors: Tracy Q
authors: TQ
authors: Callister
authors: Department of Radiology and Medicine, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA. Electronic address: jkm2001@med.cornell.edu.
authors: James K
authors: JK
authors: Min
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D019540:Area Under Curve; D002423:Cause of Death; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000401:mortality
keywords: All-cause death; Coronary artery calcification; Discrimination; Elderly; Reclassification; Risk factors