Obisesan Olufunmilayo H, Osei Albert D, Berman Daniel, Dardari Zeina A, Uddin S M Iftekhar, Dzaye Omar, Orimoloye Olusola A, Budoff Matthew J, Miedema Michael D, Rumberger John, Mirbolouk Mohammadhassan, Boakye Ellen, Johansen Michelle C, Rozanski Alan, Shaw Leslee J, Han Donghee, Nasir Khurram, Blaha Michael J
Johns Hopkins University School of Medicine, Baltimore, Maryland.
Medstar Union Memorial Hospital, Baltimore, Maryland.
Am J Cardiol. 2021 Jun 1;148:16-21. doi: 10.1016/j.amjcard.2021.02.038. Epub 2021 Mar 3.
Thoracic aortic calcium(TAC) is an important marker of extracoronary atherosclerosis with established predictive value for all-cause mortality. We sought to explore the predictive value of TAC for stroke mortality, independent of the more established coronary artery calcium (CAC) score. The CAC Consortium is a retrospectively assembled database of 66,636 patients aged ≥18 years with no previous history of cardiovascular disease, baseline CAC scans for risk stratification, and follow-up for 12 ± 4 years. CAC scans capture the adjacent thoracic aorta, enabling assessment of TAC from the same images. TAC was available in 41,066 (62%), and was primarily analyzed as present or not present. To account for competing risks for nonstroke death, we utilized multivariable-adjusted Fine and Gray competing risk regression models adjusted for traditional cardiovascular risk factors and CAC score. The mean age of participants was 53.8 ± 10.3 years, with 34.4% female. There were 110 stroke deaths during follow-up. The unadjusted subdistribution hazard ratio (SHR) for stroke mortality in those who had TAC present compared with those who did not was 8.80 (95% confidence interval [CI]: 5.97, 12.98). After adjusting for traditional risk factors and CAC score, the SHR was 2.21 (95% CI:1.39,3.49). In sex-stratified analyses, the fully adjusted SHR for females was 3.42 (95% CI: 1.74, 6.73) while for males it was 1.55 (95% CI: 0.83, 2.90). TAC was associated with stroke mortality independent of CAC and traditional risk factors, more so in women. The presence of TAC appears to be an independent risk marker for stroke mortality.
胸主动脉钙化（TAC）是冠状动脉外动脉粥样硬化的重要标志物，对全因死亡率具有既定的预测价值。我们试图探讨TAC对卒中死亡率的预测价值，独立于更成熟的冠状动脉钙化（CAC）评分。CAC联盟是一个回顾性收集的数据库，包含66636名年龄≥18岁、既往无心血管疾病史、进行基线CAC扫描以进行风险分层并随访12±4年的患者。CAC扫描可捕捉相邻的胸主动脉，从而能够从相同图像中评估TAC。41066名（62%）患者有TAC数据，主要分析为有或无TAC。为了考虑非卒中死亡的竞争风险，我们使用了多变量调整的Fine和Gray竞争风险回归模型，并对传统心血管危险因素和CAC评分进行了调整。参与者的平均年龄为53.8±10.3岁，女性占34.4%。随访期间有110例卒中死亡。有TAC者与无TAC者相比，卒中死亡率的未调整亚分布风险比（SHR）为8.80（95%置信区间[CI]：5.97，12.98）。在调整传统危险因素和CAC评分后，SHR为2.21（95%CI：1.39，3.49）。在按性别分层的分析中，女性的完全调整后SHR为3.42（95%CI：1.74，6.73），而男性为1.55（95%CI：0.83，2.90）。TAC与卒中死亡率相关，独立于CAC和传统危险因素，在女性中更为明显。TAC的存在似乎是卒中死亡率的独立风险标志物。
