{"doi":"10.1016/j.jacadv.2025.102232","title":"Association of Quantitative Coronary Artery Calcium Density Subtype Volumes With Major Adverse Cardiovascular Events","abstract":"BACKGROUND: Growing evidence has demonstrated that low density coronary artery calcification (CAC) is associated with a higher risk of cardiovascular events. OBJECTIVES: We aim to explore the relationship between CAC volumes at predefined densities, assessed by CAC volume according to CAC Hounsfield unit (HU), and major adverse cardiac events (MACEs). METHODS: We evaluated 3 patient groups with no prior coronary artery disease history who underwent an electrocardiogram-gated noncontrast computed tomography scan for CAC scanning (CAC group, n = 2,028) or as part of a cardiac imaging test: single-photon emission computed tomography (SPECT)-myocardial perfusion imaging (SPECT group, n = 2,782), and positron emission tomography (PET)-myocardial perfusion imaging (PET group, n = 2,366). CAC subtype volumes of low, intermediate, and high density based on HU cutoff (low: 130-199 HU, intermediate: 200-399 HU, and high: ≥400 HU). MACE included mortality, myocardial infarction, unstable angina, and late revascularization. RESULTS: During a median 4.3 years (interquartile ranges: 2.6-12.8) follow-up duration, 1,033 MACE occurred (14.4%). In multivariable analysis, low-density CAC volume was independently predictive of MACE (log-transformed; CAC group: HR: 1.65; 95% CI: 1.05-2.60; SPECT group: HR: 1.41, 95% CI: 1.02-1.94; PET group: HR: 1.34, 95% CI: 1.11-1.61; P < 0.05), whereas intermediate and high-density volumes were not (P > 0.05). Density CAC volumes improved discrimination and reclassification among all 3 groups (CAC, SPECT, and PET groups: global chi-square improvement: 9.1, 16.1, and 16.6, respectively, P < 0.01; net reclassification index: 47.3, [95% CI: 33.2-61.4], 49.6 [95% CI: 36.8-62.4] and 15.4, [95% CI: 5.9-24.9], respectively, P < 0.01). CONCLUSIONS: Low-density HU volume was independently associated with an increased MACE risk and improved discrimination and reclassification over conventional approaches in a broad spectrum of individuals undergoing CAC scanning.","journal":"JACC Advances","year":2025,"id":579086,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8316,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1225010,"name":"Aakash Shanbhag","orcid":"0000-0001-5199-3071","position":1,"is_corresponding":false},{"id":1218317,"name":"Jianhang Zhou","orcid":"0000-0002-2423-2311","position":2,"is_corresponding":false},{"id":1489323,"name":"Sunam Lee","orcid":"0000-0003-1467-122X","position":3,"is_corresponding":false},{"id":1218318,"name":"Parker Waechter","orcid":"0009-0007-8829-1402","position":4,"is_corresponding":false},{"id":253727,"name":"Heidi Gransar","orcid":"0000-0003-4704-8290","position":5,"is_corresponding":false},{"id":316506,"name":"Timothy M. Bateman","orcid":"0009-0007-7959-6159","position":6,"is_corresponding":false},{"id":316500,"name":"Robert J.H. Miller","orcid":"0000-0003-4676-2433","position":7,"is_corresponding":false},{"id":484159,"name":"John D. Friedman","orcid":null,"position":8,"is_corresponding":false},{"id":1489725,"name":"Sean Hayes","orcid":null,"position":9,"is_corresponding":false},{"id":402100,"name":"Louise Thomson","orcid":"0000-0001-7492-7827","position":10,"is_corresponding":false},{"id":259171,"name":"Damini Dey","orcid":"0000-0003-2236-6970","position":11,"is_corresponding":false},{"id":253731,"name":"Daniel S. Berman","orcid":"0000-0002-3793-9578","position":12,"is_corresponding":false},{"id":259173,"name":"Piotr J. Slomka","orcid":"0000-0002-6110-938X","position":13,"is_corresponding":false},{"id":253724,"name":"Donghee Han","orcid":"0000-0003-1491-3612","position":0,"is_corresponding":true}],"reference_count":0,"raw_metadata":null,"created_at":"2026-07-19T02:58:30.282164Z","pmid":"41135382","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}