Prognostic Value of Number and Site of Calcified Coronary Lesions Compared With the Total Score
Marcus Williams, MD*,
Leslee J. Shaw, PhD*,*,
Paolo Raggi, MD*,
Douglas Morris, MD*,
Viola Vaccarino, MD, PhD*,
Sandy T. Liu, MD ,
Steven R. Weinstein, MD,
Tristen P. Mosler, MD,
Philip H. Tseng, MD,
Ferdinand R. Flores, MD,
Khurram Nasir, MD, MPH,
Matthew Budoff, MD
* Emory University School of Medicine, Atlanta, Georgia
Los Angeles Biomedical Research Institute, Torrance, California.
View larger version (19K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 1 The Frequency of Calcified Lesions by Coronary Artery
This figure plots the percent of patients with the total number of calcified lesions for the left anterior descending (LAD), left main (LM), right coronary (RCA), and left circumflex (LCx) coronary arteries. The total number of lesions varies by the epicardial coronary artery but ranges from 1 to 23 lesions. Any lesion was more frequent in the LAD but also common in the RCA and LCx coronary arteries. Only 0.6% of patients had 3 or more lesions in the LM coronary artery.
|
|
View larger version (13K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 2 Risk-Adjusted Annual Mortality (95% Confidence Intervals) by the Number of Calcified Lesions
This figure plots predicted or risk-adjusted annual mortality rates, including 95% confidence intervals, by the number of calcified lesions. These results are based on data from a Cox proportional hazards multivariable model that included the number of calcified lesions plus cardiac risk factors. There is a directly proportional relationship between mortality risk and the number of calcified lesions such that mortality rates increase in patients with more frequent calcified lesions.
|
|
View larger version (11K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 3 Risk-Adjusted Annual Mortality for CAC Score Subsets by the Number of Calcified Lesions CAC  100
This figure plots predicted or risk-adjusted annual mortality rates by the number of calcified lesions in the LAD or LM, RCA, and LCx coronary arteries. These results are based on data from a Cox proportional hazards multivariable model that included the number of calcified lesions plus cardiac risk factors. For all coronary arteries, mortality rates are higher for patients with more frequent calcified lesions. However, mortality rates were highest for patients with calcified lesions in the LAD or LM coronary arteries. CAC = coronary artery calcium; other abbreviations as in Figure 1.
|
|
View larger version (14K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 4 Cumulative Risk-Adjusted Cox Survival for Patients with 1 Calcified Lesion (n = 5,165)
This survival curve is based on a Cox proportional hazards univariable regression model that includes only patients with 1 calcified lesion. These results indicate that patients with large coronary artery calcium scores, in that 1 lesion, had worse cumulative survival (p < 0.0001).
|
|
View larger version (20K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 5 Risk-Adjusted Annual Mortality for CAC Score Subsets by the Number of Calcified Lesions
This figure plots predicted or risk-adjusted annual mortality rates by the number of calcified lesions and coronary artery calcium (CAC) score results. These results are based on data from a Cox proportional hazards multivariable model that included the number of calcified lesions, the CAC score, and cardiac risk factors. Although mortality rates increased for patients with more frequent lesions as well as for those with higher CAC scores, mortality rates were highest for patients with few, very large calcified lesions.
|
|
View larger version (16K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 6 ROC Curves for the Total Number of Calcified Lesions Compared With the Agatston Score
The receiver-operating characteristic (ROC) curve plots the sensitivity (y-axis) by 1 – specificity (or false positive rate, x-axis) for both the total number of lesions and the Agatston or coronary artery calcium score. These results reveal a similar ability to classify mortality risk for both the Agatston score and the number of calcified lesions.
|
|
|
