Interplay Between Risk Factors And Coronary Artery Calcium In Middle-Aged And Elderly Symptomatic Patients

Objective: Coronary artery disease(CAD)is positively and independently linked with the various traditional risk factors.coronary artery calcium(CAC)can be utilized to evaluate the risk and outcomes of CAD.Whether CAC combined with risk factor burdens predicts major adverse cardiovascular and cerebrovascular events(MACCE)remains to be investigated.This study aimed to explore the prognostic value of CAC score combined with risk factors in symptomatic middle-aged and elderly patients.Methods: From December 2013 to September 2020,this study included 7432 middle-aged and elderly symptomatic patients(aged over 55)with chest pain who received coronary computer tomography angiography(CTA)at the First Affiliated Hospital of Xinjiang Medical University.The overall clinical data,laboratory data,and CTA data of all patients were gathered.The primary outcome was major adverse cardiac and cerebrovascular events(MACCE),which was defined as a composite outcome of nonfatal myocardial infarction,revascularization(percutaneous coronary intervention or coronary artery bypass graft),stroke,and cardiovascular death.Secondary outcomes included congestive heart failure,cardiogenic shock,malignant arrhythmia,and all-cause death.Results: There are 970(13%)patients with CAC 0–10,2331(31%)patients with CAC 11–100,and 4131(56%)patients with CAC ≥101.The proportion of patients aged 55-65 years,65–75 years and≥75 years was 40.7%,38.1% and 21.2%,respectively.The total number of MACCEs over the 3.4 years follow-up period was 478.The percentage of CAC ≥101 was higher among the 75-year-old group than the 55–65-year-old group,increasing from 46.5% to 68.2%.With the increase in the CAC score,the proportion of patients aged ≥75 years increased from 12.9% to 25.8%,compared to those aged 55–65 years.The number of risk factors gradually increased as the CAC scores increased in the symptomatic patients aged over 55 years and the similar tendencies were observed among the different age subgroups.The proportion of non-obstructive CAD was comparable between the three age groups(53.5%vs 51.9% vs 49.1%),but obstruction CAD increased with age.The incidence of MACCE in the group with CAC ≥101 and ≥4 risk factors was 1.71 times higher(95% confidence interval(CI))1.01–2.92;P = 0.044)than the rate in the group with CAC ≥101 and 1 risk factor.In the CAC 0-10 group,the incidence of MACCE in patients aged ≥75 years was12.65 times higher(95% CI: 6.74–23.75;P < 0.0001)than that in patients aged 55–65years.By taking into account the combination of CAC score,age,and risk factor burden,the predictive power of MACCE can be increased(area under the curve(AUC)= 0.614).Conclusions: In symptomatic patients aged 55 or above,a rise in age,CAC scores,and risk factor burden was linked to a considerable risk of future MACCE.In addition,combining CAC scores,age and risk factors can more accurately predict outcomes for middle-aged and elderly patients with symptoms.