Nomogram to Predict Survival in Asymptomatic Patients Using CACS

Study Questions:

How valid is a simple-to-use nomogram for prediction of 5-, 10-, and 15-year survival among asymptomatic adults utilizing coronary artery calcium scoring (CACS)?


A total of 9,715 persons (mean age, 53.4 ± 10.5 years; 59.3% male) physician referred for a CACS were used to develop a nomogram using Cox proportional hazards regression modeling that included: age, sex, smoking, hypertension, dyslipidemia, diabetes, family history of coronary artery disease, and CACS. A prognostic index (PI) summing the number of risk points corresponding to weighted covariates was used to configure the nomogram.


A total of 936 and 294 deaths occurred in the derivation and validation sets at a median follow-up of 14.6 years (interquartile range, 13.7-15.5 years) and 9.4 years (interquartile range, 6.8-11.5 years), respectively. The developed model effectively predicted 5-, 10-, and 15-year probability of survival. The PI displayed high discrimination in the derivation and validation sets (C-index 0.74 and 0.76, respectively).


A simple-to-use nomogram effectively predicts 5-, 10-, and 15-year survival for asymptomatic adults undergoing screening for cardiac risk factors. This nomogram may be considered for use in clinical care.


While the relative accuracy of predicting all-cause mortality using the tool is much better than intuitive, it has little clinical application compared to the MESA (Multi-Ethnic Study of Atherosclerosis) study that uses coronary risk factor values and CACS to predict 10-year coronary heart disease risk, and the Reynold Risk Score that incorporates high-sensitivity C-reactive protein and risk factors to predict 10-year risk of coronary heart disease and stroke.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Noninvasive Imaging, Prevention, Hypertension, Smoking

Keywords: Cardiac Imaging Techniques, Coronary Artery Disease, Diabetes Mellitus, Dyslipidemias, Hypertension, Nomograms, Plaque, Atherosclerotic, Primary Prevention, Risk Factors, Smoking, Survival

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