Thoracic Aortic Calcium For The Prediction Of Stroke Mortality (From The Coronary Artery Calcium Consortium)

AUTHORS

Obisesan OH , Osei AD , Berman D , Dardari ZA , Uddin SMI , Dzaye O , Orimoloye OA , Budoff MJ , Miedema MD , Rumberger J , Mirbolouk M , Boakye E , Johansen MC , Rozanski A , Shaw LJ , Han D , Nasir K , Blaha MJ , . The American journal of cardiology. 2021 3 2; ().

PMID: 33667445 [PubMed].

ABSTRACT

Thoracic aortic calcium(TAC) is an important marker of extra-coronary atherosclerosis with established predictive value for all-cause mortality. We sought to explore the predictive value of TAC for stroke mortality, independent of the more established coronary artery calcium(CAC) score. The CAC Consortium is a retrospectively assembled database of 66,636 patients aged ≥18 years with no prior history of cardiovascular disease, baseline CAC scans for risk stratification, and follow-up for 12±4 years. CAC scans capture the adjacent thoracic aorta, enabling assessment of TAC from the same images. TAC was available in 41,066 (62%), and was primarily analyzed as present or not present. To account for competing risks for non-stroke death, we utilized multivariable-adjusted Fine and Gray competing risk regression models adjusted for traditional cardiovascular risk factors and CAC score. The mean age of participants was 53.8±10.3 years, with 34.4% female. There were 110 stroke deaths during follow-up. The unadjusted sub-distribution hazard ratio(SHR) for stroke mortality among those who had TAC present compared to those who did not was 8.80(95%CI:5.97,12.98). After adjusting for traditional risk factors and CAC score, the SHR was 2.21(95%CI:1.39,3.49). In sex-stratified analyses, the fully adjusted SHR for females was 3.42(95%CI:1.74,6.73) while for males it was 1.55(95%CI:0.83,2.90). TAC was associated with stroke mortality independent of CAC and traditional risk factors, more so in women. The presence of TAC appears to be an independent risk marker for stroke mortality.

Tags: alumni publications 2021