Table 1.
Baseline Characteristics of Study Participants. Comparison of patients with coronary microcalcification activity (CMA) ≥1.56 vs <1.56, with Target to Background ratio (TBR) ≥1.28 vs <1.28 and coronary calcium score ≥1199 vs <1199.
| CMA | TBR | CCS | |||||||
|---|---|---|---|---|---|---|---|---|---|
| ≥ 1.56 (n=109) | < 1.56 (n=184) | P | ≥1.28 (n=113) | <1.28 (n=180) | P | ≥1199 (n=45) | <1199 (n=248) | P | |
| Age in years, mean (SD) | 67 (8) | 64 (9) | 0.0047 | 67 (8) | 63 (9) | 0.0001 | 68 (8) | 64 (9) | 0.006 |
| Men, n (%) | 97 (89%) | 148 (80%) | 0.071 | 103 (91%) | 142 (79%) | 0.006 | 44 (98%) | 201 (81%) | 0.004 |
| Body-mass index (kg/m2), mean (SD) | 28 (5) | 30 (5) | 0.024 | 29 (6) | 29 (5) | 1.00 | 30 (5) | 29 (5) | 0.22 |
| Systolic blood pressure (mm Hg), mean (SD) | 142 (21) | 141 (20) | 0.68 | 142 (20) | 141 (20) | 0.68 | 143 (15) | 141 (21) | 0.54 |
| Diastolic blood pressure (mm Hg), mean (SD) | 79 (12) | 80 (11) | 0.46 | 78 (11) | 80 (12) | 0.15 | 78 (11) | 80 (11) | 0.26 |
| Cardiovascular history, n (%) | |||||||||
| H of ACS | 53 (48.6%) | 108 (58.7%) | 0.11 | 58 (51.3%) | 103 (57.2%) | 0.34 | 25 (55.6%) | 136 (54.8%) | 1.00 |
| H of PCI | 64 (58.7%) | 119 (64.7%) | 0.32 | 69 (61.1%) | 114 (93.3%) | 0.71 | 23 (51.1%) | 160 (64.5%) | 0.10 |
| H of CABG | 20 (18.3%) | 28 (15.2%) | 0.52 | 21 (18.6%) | 27 (15.0%) | 0.44 | 23 (51.1%) | 25 (10.1%) | 0.0001 |
| H of angina | 60 (55.0%) | 76 (41.3%) | 0.029 | 57 (50.4%) | 79 (43.9%) | 0.28 | 30 (66.7%) | 106 (42.7%) | 0.003 |
| CVA/TIA | 3 (2.8%) | 6 (3.3%) | 1.000 | 3 (2.7%) | 6 (3.3%) | 1.00 | 1 (2.2%) | 8 (3.2%) | 1.00 |
| Comorbidities/risk factors, n (%) | |||||||||
| HTN | 71 (65.1%) | 103 (55.9%) | 0.14 | 76 (67.3%) | 98 (54.4%) | 0.038 | 30 (66.7%) | 144 (58.1%) | 0.32 |
| HPL | 97 (89.0%) | 160 (86.9%) | 0.71 | 101 (89.3%) | 156 (86.7%) | 0.58 | 40 (88.9%) | 217 (87.5%) | 1.00 |
| DM | 26 (23.9%) | 35 (19.0%) | 0.37 | 26 (23.0%) | 35 (19.4%) | 0.46 | 13 (28.9%) | 48 (19.4%) | 0.16 |
| Current smoking | 20 (18.3%) | 38 (21.1%) | 0.65 | 21 (18.6%) | 37 (20.6%) | 0.76 | 8 (17.8%) | 50 (20.2%) | 0.84 |
| Ex-smoker | 44 (40.3%) | 93 (51.7%) | 0.12 | 51 (45.1%) | 86 (47.8%) | 0.72 | 19 (42.2%) | 118 (47.6%) | 0.52 |
| Atrial fibrillation | 4 (3.7%) | 6 (3.3%) | 1.00 | 5 (4.4%) | 5 (2.8%) | 0.52 | 2 (4.4%) | 8 (3.2%) | 0.65 |
| Peripheral vascular disease | 4 (3.7%) | 12 (6.5%) | 0.43 | 4 (3.5%) | 12 (6.7%) | 0.30 | 8 (17.8%) | 8 (3.2%) | 0.0008 |
| Medications, n (%) * | |||||||||
| Aspirin | 101 (92.7%) | 167 (90.7%) | 0.67 | 107 (94.7%) | 161 (89.4%) | 0.14 | 41 (91.1%) | 227 (91.5%) | 1.00 |
| PY12 antagonist | 19 (17.4%) | 26 (14.1%) | 0.50 | 21 (18.6%) | 24 (13.3%) | 0.25 | 5 (11.1%) | 40 (16.1%) | 0.50 |
| Statin | 102 (93.6%) | 160 (86.9%) | 0.08 | 103 (91.2%) | 159 (88.3%) | 0.56 | 42 (93.3%) | 220 (88.7%) | 0.44 |
| Beta Blocker | 72 (66.1%) | 124 (67.4%) | 0.90 | 77 (68.1%) | 119 (66.1%) | 0.80 | 32 (71.1%) | 164 (66.1%) | 0.61 |
| ACEI/ARB | 76 (69.7%) | 121 (65.7%) | 0.61 | 81 (71.7%) | 116 (64.4%) | 0.20 | 38 (84.4%) | 159 (64.1%) | 0.009 |
| Insulin | 1 (0.9%) | 3 (1.6%) | 1.00 | 1 (0.9%) | 3 (1.7%) | 1.00 | 0 | 4 (1.4%) | 1.00 |
| Oral diabetic medications | 17 (15.6%) | 31 (16.8%) | 0.87 | 19 (16.8%) | 29 (1.6%) | 0.87 | 8 (17.8%) | 40 (16.1%) | 0.83 |
| CCB | 23 (21.1%) | 40 (21.7%) | 1.00 | 27 (23.9%) | 36 (20.0%) | 0.47 | 12 (26.7%) | 51 (20.6%) | 0.43 |
| Diuretics | 7 (6.4%) | 31 (16.8%) | 0.028 | 7 (6.2%) | 31 (17.2%) | 0.007 | 7 (15.6%) | 31 (12.5%) | 0.63 |
| Biomarkers, median (IQR) | |||||||||
| Total Cholesterol (mmol/L) | 4.0 (3.5–4.7) | 4.1 (3.6–4.8) | 0.41 | 4.0 (3.5–4.8) | 4.1 (3.6–4.7) | 0.63 | 4.2 (3.5–4.9) | 3.8 (4.1–4.7) | 0.53 |
| LDL (mmol/L) | 1.9 (1.3–2.5) | 1.9 (1.2–2.4) | 0.75 | 1.7 (1.2–2.5) | 2.1 (1.4–2.4) | 0.21 | 2.2 (1.2–2.7) | 1.9 (1.2–2.4) | 0.12 |
| HDL (mmol/L) | 1.2 (1.0–1.7) | 1.2 (1.0–1.8) | 0.76 | 1.2(1.0–1.7) | 1.2 (1.0–1.7) | 0.69 | 1.2 (1.0–1.7) | 1.2 (1.0 –1.7) | 0.74 |
| TAG (mmol/L) | 1.5 (1.1–2.5) | 1.6 (1.1–2.2) | 0.87 | 1.5(1.0–2.5) | 1.5 (1.1–2.2) | 0.87 | 1.4 (1.2–2.0) | 1.6 (1.1–2.4) | 0.37 |
| Creatinine (μmol/L) | 80 (70–94) | 77 (70–89) | 0.42 | 78(70–88) | 78(70–92) | 0.95 | 80 (70–91) | 77 (70–90) | 0.48 |
| CAD, n (%) | |||||||||
| Non-obstructive disease (<50%) | 5 (4.6%) | 10 (5.4%) | 0.79 | 2 (1.8%) | 13 (7.2%) | 0.05 | 1 (2.2%) | 14 (5.6%) | 0.48 |
| Single vessel disease | 31 (28.4%) | 56 (30.4%) | 1.00 | 29 (25.7%) | 58 (32.2%) | 0.24 | 8 (17.8%) | 79 (31.9%) | 0.08 |
| Two vessel disease | 37 (33.9%) | 73 (39.7%) | 0.38 | 44 (38.9%) | 66 (36.7%) | 0.71 | 12 (26.7%) | 98 (39.5%) | 0.13 |
| Three vessel disease | 36 (33.0%) | 45 (24.5%) | 0.10 | 38 (33.6%) | 43 (23.9%) | 0.081 | 24 (53.3%) | 57 (23.0%) | 0.0001 |
| LMS involvement | 7 (6.4%) | 7 (3.8%) | 0.40 | 7 (6.2%) | 7 (3.9%) | 0.41 | 7 (15.6%) | 7 (2.8%) | 0.002 |
| Coronary Stent, n (%) | 83 (76.1%) | 135 (73.4%) | 0.68 | 85 (75.2%) | 133 (73.9%) | 0.89 | 24 (53.3%) | 194 (78.2%) | 0.0013 |
| Segment involvement score. Median (IQR) | 6 (4–8) | 5 (3–7) | 0.008 | 4 (6–8) | 5(3–7) | 0.002 | 7 (6–9) | 5 (3–7) | <0.0001 |
| SIS breakdown, n (%) | |||||||||
| 0–1 | 4 (3.7%) | 16 (8.7%) | 0.15 | 3 (2.7%) | 17 (9.4%) | 0.030 | 1 (2.2%) | 19 (7.7%) | 0.33 |
| 2–3 | 19 (16.4%) | 36 (19.6%) | 0.76 | 14 (12.3%) | 41 (22.8%) | 0.031 | 0 | 55 (22.2%) | 0.0001 |
| 4–5 | 23 (21.1%) | 50 (27.2%) | 0.27 | 29 (25.6%) | 44 (24.4%) | 0.89 | 5 (11.1%) | 68 (27.4%) | 0.02 |
| >5 | 63 (57.8%) | 82 (44.6%) | 0.016 | 67 (59.3%) | 78 (43.3%) | 0.009 | 39 (86.7%) | 106 (42.7%) | 0.0001 |
| CCS, median (IQR) | 544 (184–1157) | 201 (64–541) | <0.0001 | 498 (188–1089) | 201 (59–558) | <0.0001 | N/A | N/A | N/A |
| CCS, n (%) | |||||||||
| 0–99 | 21 (19.3%) | 63 (34.2%) | 0.007 | 20 (17.7%) | 64 (35.6%) | 0.0009 | |||
| 100–399 | 24 (22.0%) | 52 (28.3%) | 0.27 | 25 (22.1%) | 51 (28.3%) | 0.2742 | |||
| 400–999 | 27 (24.8%) | 47 (25.5%) | 1.00 | 33 (29.2%) | 41 (22.8%) | 0.2691 | |||
| >1000 | 37 (33.9%) | 22 (12.0%) | 0.0001 | 35 (31.0%) | 24 (13.3%) | 0.0003 | |||
| TBR, median (IQR) | 1.45 (1.31–1.62) | 1.13 (1.05–1.22) | <0.001 | 1.45 (1.35–1.62) | N/A | N/A | 1.4 (1.23–1.62) | 1.2 (1.1–1.4) | <0.0001 |
| TBR≥1.28 | 86 (78.9%) | 27 (14.7%) | 0.0001 | N/A | N/A | N/A | 26 (57.8%) | 87 (35.1%) | 0.005 |
| CCS>1199 | 27 (24.8%) | 19 (10.3%) | 0.0015 | 26 (23.0%) | 20 (11.1%) | 0.0082 | N/A | N/A | N/A |
| Risk scores | |||||||||
| REACH score (IQR) CV event | 13 (11–15) | 13 (11–15) | 0.075 | 14 (12–16) | 12 (10–15) | 0.0039 | 15 (13–17) | 13 (11–15) | <0.0001 |
| 20-month risk of next CV event, % (IQR) | 6.3 (4.7–8.5) | 6.3 (4.7–8.5) | 0.13 | 7.3 (4.7–9.2) | 5.4 (4.0–8.5) | 0.0074 | 8.5 (6.3–11.0) | 5.4 (4.7–8.5) | <0.0001 |
| REACH score (IQR) CV death | 11 (10–13) | 11 (9–13) | 0.015 | 11 (10–13) | 11 (9–12) | 0.0012 | 12 (11–14) | 11 (9–12) | <0.0001 |
| 20-month cardiovascular death, % (IQR) | 1.8 (1.4–3.0) | 1.8 (1.1–2.8) | 0.014 | 1.8 (1.4–3.0) | 1.5 (1.0–2.0) | 0.0011 | 2.3 (1.8–3.8) | 1.8 (1.1 –2.3) | <0.0001 |
| Duke score | 4 (3–5) | 4 (3–5) | 0.28 | 4 (3–5) | 4 (3–5) | 0.0324 | 5 (4–5) | 4 (3–5) | 0.0024 |
| SMART risk score | 21 (15–27) | 17 (12–24) | 0.0050 | 20 (14–28) | 17 (13–24) | 0.0414 | 24 (18–32) | 17 (13–24) | 0.0002 |
| Outcomes | |||||||||
| Myocardial infarction | 16 (14.7%) | 4 (2.2%) | 0.0001 | 16 (14.2%) | 4 (2.2%) | 0.0002 | 13 (15.6%) | 7 (5.2%) | 0.08 |
| MACE | 23 (21.1%) | 17 (9.2%) | 0.008 | 23 (20.4) | 17 (9.4%) | 0.0078 | 10 (22.2%) | 30 (12.1%) | 0.10 |
| Stroke | 3 | 9 | 0.045 | 3 | 9 | 0.045 | 1 | 11 | 0.003 |
| Cardiovascular death | 2 | 1 | N/A | 2 | 1 | N/A | 0 | 3 | N/A |
| Delayed revascularization | 2 | 3 | N/A | 2 | 3 | N/A | 0 | 5 | N/A |
ACEI/ARB – angiotensin converting enzyme inhibitor/angiotensin receptor blocker, ACS – acute coronary syndrome, CABG – coronary artery bypass graft, CAD – coronary artery disease, CMA – coronary microcalcification activity, CVA – Cerebrovascular accident, MACE – major adverse cardiovascular event, PCI – percutaneous coronary intervention, REACH - Reduction of Atherothrombosis for Continued Health, SMART Secondary Manifestations of Arterial Disease, SIS – segment involvement score, TAG - triacylglycerides, TBR – target to background ratio, TIA - transient ischemic attack
*
medications at the time of scan