Validation of the Coronary Artery Calcium Data and Reporting System (CAC-DRS): Dual importance of CAC score and CAC distribution from the Coronary Artery Calcium (CAC) consortium

Omar Dzaye, Ramzi Dudum, Mohammadhassan Mirbolouk, Olusola A. Orimoloye, Albert D. Osei, Zeina A. Dardari, Daniel S. Berman, Michael D. Miedema, Leslee Shaw, Alan Rozanski, Matthias Holdhoff, Khurram Nasir, John A. Rumberger, Matthew J. Budoff, Mouaz H. Al-Mallah, Ron Blankstein, Michael J. Blaha

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: The Coronary Artery Calcium Data and Reporting System (CAC-DRS), which takes into account the Agatston score category (A) and the number of calcified vessels (N) has not yet been validated in terms of its prognostic significance. Methods: We included 54,678 patients from the CAC Consortium, a large retrospective clinical cohort of asymptomatic individuals free of baseline cardiovascular disease (CVD). CAC-DRS groups were derived from routine, cardiac-gated CAC scans. Cox proportional hazards regression models, adjusted for traditional CVD risk factors, were used to assess the association between CAC-DRS groups and CHD, CVD, and all-cause mortality. CAC-DRS was then compared to CAC score groups and regional CAC distribution using area under the curve (AUC) analysis. Results: The study population had a mean age of 54.2 ± 10.7, 34.4% female, and mean ASCVD score 7.3% ± 9.0. Over a mean follow-up of 12 ± 4 years, a total of 2,469 deaths (including 398 CHD deaths and 762 CVD deaths) were recorded. There was a graded risk for CHD, CVD and all-cause mortality with increasing CAC-DRS groups ranging from an all-cause mortality rate of 1.2 per 1,000 person-years for A0 to 15.4 per 1,000 person-years for A3/N4. In multivariable-adjusted models, those with CAC-DRS A3/N4 had significantly higher risk for CHD mortality (HR 5.9 (95% CI 3.6–9.9), CVD mortality (HR4.0 (95% CI 2.8–5.7), and all-cause mortality a (HR 2.5 (95% CI 2.1–3.0) compared to CAC-DRS A0. CAC-DRS had higher AUC than CAC score groups (0.762 vs 0.754, P < 0.001) and CAC distribution (0.762 vs 0.748, P < 0.001). Conclusion: The CAC-DRS system, combining the Agatston score and the number of vessels with CAC provides better stratification of risk for CHD, CVD, and all-cause death than the Agatston score alone. These prognostic data strongly support new SCCT guidelines recommending the use CAC-DRS scoring.

Original languageEnglish (US)
Pages (from-to)12-17
Number of pages6
JournalJournal of cardiovascular computed tomography
Issue number1
StatePublished - Jan 1 2020


  • Computed tomography
  • Coronary artery calcium
  • Coronary artery calcium data and reporting system

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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