a Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, ALb UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, ALc UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, ALd Department of Radiology, University of Alabama at Birmingham, Birmingham, ALe Department of Radiology, University of Michigan, Ann Arbor, MIf Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MIg Department of Radiology, University of Iowa, Iowa City, IAh Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, COi Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CAj Department of Radiology, Temple University Hospital, Philadelphia, PAk Department of Radiology, Brigham and Women's Hospital, Boston, MAl Department of Radiology, University of California at San Diego, San Diego, CAm Birmingham VA Medical Center, Birmingham, ALn Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
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BACKGROUND:COPD is associated with cardiovascular disease (CVD), and coronary artery calcification (CAC) provides additional prognostic information. With increasing use of nongated CT scans in clinical practice, this study hypothesized that the visual Weston CAC score would perform as well as the Agatston score in predicting prevalent and incident coronary artery disease (CAD) and CVD in COPD.METHODS:CAC was measured by using Agatston and Weston scores on baseline CT scans in 1,875 current and former smokers enrolled in the Genetic Epidemiology of COPD (COPDGene) study. Baseline cardiovascular disease and incident cardiac events on longitudinal follow-up were recorded. Accuracy of the CAC scores was measured by using receiver-operating characteristic analysis, and Cox proportional hazards analyses were used to estimate the risk of incident cardiac events.RESULTS:CAD was reported by 133 (7.1%) subjects at baseline. A total of 413 (22.0%) and 241 (12.9%) patients had significant CAC according to the Weston (≥ 7) and Agatston (≥ 400) scores, respectively; the two methods were significantly correlated (r = 0.84; P < .001). Over 5 years of follow-up, 127 patients (6.8%) developed incident CVD. For predicting prevalent CAD, c-indices for the Weston and Agatston scores were 0.78 and 0.74 and for predicting incident CVD, they were 0.62 and 0.61. After adjustment for age, race, sex, smoking pack-years, FEV1, percent emphysema, and CT scanner type, a Weston score ≥ 7 was associated with time to first acute coronary event (hazard ratio, 2.16 [95% CI, 1.32 to 3.53]; P = .002), but a Agatston score ≥ 400 was not (hazard ratio, 1.75 [95% CI, 0.99-3.09]; P = .053).CONCLUSIONS:A simple visual score for CAC performed well in predicting incident CAD in smokers with and without COPD.TRIAL REGISTRY:ClinicalTrials.gov; No.: NCT00608764; URL: www.clinicaltrials.gov.