Coronary artery calcification outperforms thoracic aortic calcification for the prediction of myocardial infarction and all-cause mortality: The Heinz Nixdorf Recall Study

Introduction: There has been a continuous debate about the survival benefit of percutaneous coronary intervention (PCI) for the management of patients with stable coronary artery disease (CAD) and moderate to severe ischemia. To address this, we performed a meta-analysis of RCTs comparing PCI plus MT vs. MT alone in stable CAD patients to evaluate endpoints of all-cause mortality, cardiovascular (CV) mortality, and MI in a larger cohort of patients with objective evidence of myocardial ischemia. Methods: An electronic database search was conducted for RCTs that compared PCI on top of MT versus MT alone. A random effects model was used to calculate relative risk (RR) and 95% confidence intervals (CIs). Results: A total of 7 RCTs with 10,043 patients with a mean age of 62.54 ± 1.56 years and a median follow up of 3.9 years were identified. Among patients with (CAD) and moderate to severe ischemia by stress testing, PCI didn’t show any benefit for the primary outcome of all-cause mortality compared to MT(RR = 0.85; 95% CI 0.646-1.12; p= 0.639). There was also no benefit in cardiovascular (CV) death (RR = 0.88 ; 95% CI 0.71-1.09; p =0.18) or myocardial infarction (MI) (RR = 0.271 ; 95% CI 0.782-1.087; P =0.327) in the PCI group as compared to MT. Conclusions: Among patients with (CAD) and evidence of moderate to severe ischemia by stress testing, PCI on top of MT appears to add no mortality benefit as compared to with MT alone.

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Abstract P281: All-cause and Cardiovascular Mortality in Men With High Levels of Physical Activity and Coronary Artery Calcification

Circulation ◽

10.1161/circ.137.suppl_1.p281 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Laura F Defina ◽

Nina B Radford ◽

David Leonard ◽

Stephen W Farrell ◽

Andjelka Pavlovic ◽

...

Keyword(s):

Physical Activity ◽

Coronary Artery ◽

Coronary Artery Calcification ◽

Proportional Hazards ◽

Subclinical Atherosclerosis ◽

Activity Level ◽

Mortality Hazard ◽

Hazard Ratios ◽

All Cause Mortality

Introduction: Recent studies have suggested that extreme levels of physical activity (endurance athletes) are associated with subclinical atherosclerosis as well as increased mortality. The safety of continuing high levels of physical activity is uncertain once coronary artery calcification (CAC) is discovered. Hypothesis: We hypothesized that men performing &ge3000 MET·minutes/week of physical activity would have greater all-cause and cardiovascular (CV) mortality compared to those with &lt1500 or 1500-&lt3000 MET·minutes/week of physical activity and that mortality risk would be greater in those with CAC&ge100 compared to &lt100 Agatston units. Methods: The cohort studied included 16,109 men without prevalent CV disease who reported physical activity levels and underwent EBT or MDCT scan. Physical activity was categorized into &ge3000 (n=1,266), 1500-3000 (n=3,027), and &lt1500 (n=11,816) MET·minutes/week. CAC scanning included EBT scans (1997-2007) or MDCT scans (2007-2013), and CAC score was categorized into &ge100 (n=3,547) and &lt100 (n=12,562) Agatston units. We fit separate proportional hazards regression models to follow-up times for all-cause and CV mortality. The models included all combinations of CAC and physical activity categories and were adjusted for baseline age, smoking, BMI, cholesterol, HDLc, and systolic blood pressure. Results: The average age of participants at baseline was 51.3±8.3 years. Men with the highest activity level had a lower BMI and higher HDLc. After an average follow-up of 8.9 years, there were 329 all-cause and 60 CV deaths, including 174 all-cause and 38 CV deaths in those with CAC&ge100. The sample had 80% power to detect all-cause mortality hazard ratios &ge 1.9 and 1.8 for physical activity &ge3000 versus &lt1500 in those with CAC&lt100 and &ge100, respectively. The corresponding minimum detectable CV mortality hazard ratios were 3.5 and 2.8. Comparing physical activity &ge3000 to &lt1500 in those with CAC&ge100, the hazard ratios (95% CI) were 0.9 (0.5, 1.5) for all-cause mortality and 0.9 (0.3, 3.1) for CV mortality. Hazard ratios were similar when comparing physical activity &ge3000 to 1500-&lt3000 in those with CAC &ge100. Finally, when comparing physical activity categories, there was no evidence that hazard ratios varied by CAC category, p&gt0.7. Conclusions: This sample offers no evidence that levels of activity &ge3000 MET·minutes/week are associated with increased all-cause or CV mortality compared to those with &lt1500 or 1500- &lt3000 MET·minutes/week, regardless of CAC level.

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