Coronary Calcium in Patients With Family History of Premature Coronary Disease

Study Questions:

Does coronary artery calcium (CAC) scoring improve prognosis among patients with a family history (FH) of premature coronary artery disease (CAD)?

Methods:

Data from a single-site registry of consecutive patients referred for CAD screening were used for this analysis. All patients were asymptomatic, who were free of CAD at the time of screening. CAC scores were subset as 0, 1–10, 11–99, 100–399, and ≥400. FH of premature CAD was defined as having a primary relative who had been diagnosed with CAD prior to the age of 55 years in a male relative or 65 years in a female relative. Assessment of additional cardiovascular risk factors was also completed at that time. Median follow-up was 14.6 years. The primary outcome of interest was all-cause mortality.

Results:

A total of 9,715 patients were included in this study. All-cause mortality rates ranged from 4.7% to 25.0% for FH patients and from 5.0% to 38.0% for non-FH patients with CAC scores of 0 to >400 (p < 0.0001). Effect modification by age altered the mortality risk of CAC among FH patients. For patients aged >60 years with FH of CAD, there was a significant improvement in the area under the curve (AUC) for CAC over CAD risk factors (AUC: 0.539 vs. 0.725, p < 0.001). No such improvement was observed in FH patients aged <60 years (AUC: 0.636 vs. 0.626, p = 0.67).

Conclusions:

The investigators concluded that CAC effectively stratified mortality risk of patients with and without FH of CAD. However, for younger and lower-risk FH cohorts, CAC screening did not provide additive prognostic information beyond that of the traditional cardiac risk factors.

Perspective:

This study suggests that CAC does not add prognostic value for those under the age of 60 years. However, replication in other studies is needed, as well as information on the whether race/ethnicity influence the association of CAC and mortality prognosis. Last, information on additional outcomes such as nonfatal myocardial infarction and CVD mortality would be clinically informative.

Clinical Topics: Noninvasive Imaging, Prevention

Keywords: Coronary Artery Disease, Diagnostic Imaging, Mortality, Risk Factors, Secondary Prevention, Vascular Calcification


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