Mortality in Patients With CAC ≥1,000

Study Questions:

What is the mortality associated with a coronary artery calcium (CAC) score ≥1,000?


This study examined 66,636 asymptomatic adults from a multicenter cohort of patients with a CAC score, and compared mortality between patients with CAC scores of ≥1,000 to a reference CAC score of 0 as well as a reference CAC score of 400-999. Mortality was stratified by cardiovascular disease, coronary heart disease, cancer, and all-cause mortality.


There were 2,869 individuals with CAC ≥1,000 (mean age 66.3 ± 9.7 years, 86.3% male). Mean follow-up was 12.3 ± 3.9 years. The mean number of involved arteries was 3.5 ± 0.6 vessels, and these individuals had high rates of extracoronary calcification. After adjustment for age, gender, and risk factors, subjects with CAC ≥1,000 (vs. CAC 0) had increased rates of cardiovascular disease mortality (hazard ratio [HR], 5.0; 95% confidence interval [CI], 3.9-6.5), coronary heart disease mortality (HR, 6.8; 95% CI, 4.7-9.7), cancer mortality (HR, 1.6; 95% CI, 1.2-2.0), and all-cause mortality (HR, 2.9; 95% CI, 2.5-3.3). In a similar multivariable analysis compared to individuals with CAC 400-999, subjects with CAC ≥1,000 had increased rates of cardiovascular disease mortality (HR, 1.7; 95% CI, 1.4-2.1), coronary heart disease mortality (HR, 1.8; 95% CI, 1.4-2.4), cancer mortality (HR, 1.4; 95% CI, 1.1-1.7), and all-cause mortality (HR, 1.5; 95% CI, 1.3-1.7). On spline analysis, the adjusted mortality risk continued to increase above a CAC of 1,000, with no observed plateau of risk.


Patients with a CAC score ≥1,000 experience very high rates of mortality.


A CAC score >300 or 400 has been associated with a high risk of mortality. It has been unclear whether higher scores are associated with further increases in risk. This large multicenter cohort study finds that a CAC ≥1,000 is associated with a 50% increased risk of mortality over patients with a CAC score of 300-999. Further, on graphic analysis, there is no plateau observed, and the risk appeared to increase further above a CAC score of 1,000. These findings suggest that a CAC score of ≥1,000 identifies a cohort of individuals with a very high risk of mortality. It is possible that these individuals could benefit from more aggressive risk factor reduction, but this needs to be evaluated in future studies. These data should also inform future guidelines to reflect the increased risk observed in this population.

Clinical Topics: Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Computed Tomography, Nuclear Imaging

Keywords: Calcinosis, Cardiovascular Diseases, Coronary Artery Disease, Diagnostic Imaging, Neoplasms, Plaque, Atherosclerotic, Primary Prevention, Risk Factors, Tomography, X-Ray Computed

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