• Maros Ferencik, Karol M Pencina, Ting Liu, Khristine Ghemigian, Kristin Baltrusaitis, Joseph M Massaro, Ralph B D'Agostino, Christopher J O'Donnell, and Udo Hoffmann.
• From the Knight Cardiovascular Institute, Oregon Health and Science University, Portland (M.F.); Department of Radiology (M.F., T.L., K.G., U.H.) and Cardiac MR PET CT Program (M.F., T.L., K.G., U.H.), Massachusetts General Hospital and Harvard Medical School, Boston; Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (K.M.P.); Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, China (T.L.); Department of Mathematics, Boston University, MA (K.B., J.M.M., R.B.D.); The Framingham Heart Study of the National Heart, Lung and Blood Institute, MA (C.J.O.); and Cardiology Section, VA Boston Healthcare System, West Roxbury, MA (C.J.O.). ferencik@ohsu.edu.
• Circ Cardiovasc Imaging. 2017 Oct 1; 10 (10).

BackgroundThe presence and extent of coronary artery calcium (CAC) are associated with increased risk for cardiovascular events. We determined whether information on the distribution of CAC and coronary dominance as detected by cardiac computed tomography were incremental to traditional Agatston score (AS) in predicting incident major coronary heart disease (CHD).Methods And ResultsWe assessed total AS and the presence of CAC per coronary artery, per segment, and coronary dominance by computed tomography in participants from the offspring and third-generation cohorts of the Framingham Heart Study. The primary outcome was major CHD (myocardial infarction or CHD death). We performed multivariable Cox proportional hazards analysis and calculated relative integrated discrimination improvement. In 1268 subjects (mean age, 56.2±10.3 years, 63.2% men) with AS >0 and no history of major CHD, a total of 42 major CHD events occurred during median follow-up of 7.4 years. The number of coronary arteries with CAC (hazard ratio, 1.68 per artery; 95% confidence interval, 1.10-2.57; P=0.02) and the presence of CAC in the proximal dominant coronary artery (hazard ratio, 2.59; 95% confidence interval, 1.15-5.83; P=0.02) were associated with major CHD events after multivariable adjustment for Framingham risk score and categories of AS. In addition, measures of CAC distribution improved discriminatory capacity for major CHD events (relative integrated discrimination improvement, 0.14).ConclusionsDistribution of coronary atherosclerosis, especially CAC in the proximal dominant coronary artery and an increased number of coronary arteries with CAC, predict major CHD events independently of the traditional AS in community-dwelling men and women.© 2017 American Heart Association, Inc.

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