Higher coronary artery calcium burden predicts sudden cardiac death
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WASHINGTON — A higher coronary artery calcium burden may predict incident sudden cardiac death independent of other atherosclerotic CVD risk factors, particularly for primary prevention patients, researchers reported.
Despite significant advancements in the management of subclinical CHD in primary prevention patients, the prediction of sudden cardiac death remains “elusive,” Omar Dzaye, MD, PhD, MPH, research fellow in the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, and colleagues wrote in JACC: Cardiovascular Imaging. Sudden cardiac death risk stratification can be useful in the initial stages of CHD through the measurement of CAC, identifying patients most likely to benefit from further downstream testing.
“Coronary artery calcium burden, particularly a CAC score of at least 100, confers an increased risk for incident sudden cardiac death independent of traditional atherosclerotic CVD risk factors,” Dzaye told Healio. “Sudden cardiac death risk stratification may be most useful in the very early stages of CHD through the quantification of calcified atherosclerotic plaque burden.”
The researchers assessed the association between CAC and sudden cardiac death among 66,636 primary prevention patients from the CAC Consortium, a multi-center study that includes four high-volume centers in the U.S. The mean age of patients was 54 years, 33% were women and 89% were white. All patients were referred to undergo CAC screening (1991-2010) due to the presence of underlying ASCVD risk factors and uncertainty in long-term ASCVD risk.
The findings were presented at the American College of Cardiology Scientific Session.
Within the cohort, 55% of patients had a CAC greater than zero. More than half of patients had a 10-year ASCVD risk of less than 5%, although hypertension (31%), dyslipidemia (54.4%), and a family history of CHD (46.1%) were prevalent among study participants.
Researchers observed 211 sudden cardiac death events (0.3%) during a median of 10.6 years of follow-up, with 91% of those occurring among those with baseline CAC greater than zero.
Compared with patients with a CAC score of zero, researchers observed a stepwise higher risk for sudden cardiac death across increasing CAC burden. Adults with CAC scores of 100 to 399, 400 to 999 and greater than 1,000 had a 2.8- to 4.9-fold higher risk for sudden cardiac death compared with those with a CAC score of zero, independent of traditional risk factors (P < .0001 for trend), according to the researchers.
CAC score also provided incremental improvements in the C-statistic for the prediction of sudden cardiac death among individuals with a 10-year ASCVD risk of 20% (P = .54).
The researchers noted that, contrary to the current clinical paradigm, sudden cardiac death risk stratification may be most useful in the early stages of CHD through the quantification of calcified atherosclerotic plaque burden.
“Future studies that assess the role of CAC scoring as an initial modality to support the selective use of downstream testing, such as echocardiogram, and/or exercise treadmill testing with or without imaging or coronary CT angiography, may be useful to help further guide primary prevention strategies for sudden cardiac death risk assessment,” Dzaye told Healio.
Reference:
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Razavi A, et al. Abstract 1032-07. Presented at: American College of Cardiology Scientific Session; April 2-4, 2022; Washington, D.C. (hybrid meeting).
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