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Prevention & lipidsCohort study

Sub-Agatston coronary calcification on non-contrast cardiac CT and cardiovascular risk

Eur J Prev CardiolPublished

  • Retrospective cohort study
  • two cohorts (CLARIFY registry, SCOT-HEART trial)
Read the original article ↗

Authors' conclusion

VCI captures sub-Agatston CAC linked to HRP and independently improves MACE prediction in both a primary-prevention and a mixed-risk symptomatic chest pain population.

Study context

Population
Asymptomatic individuals (CLARIFY CT calcium score (CTCS) registry) and chest-pain clinic patients (SCOT-HEART trial) with non-contrast CT calcium scoring
Participants
1,837 vs 1,075
Exposure
Vulnerable calcium index added to Agatston score for major adverse cardiac events (MACE) prediction
  • CLARIFYn = 1,837
  • SCOT-HEARTn = 1,075
Outcome
Atherosclerotic MACE:
  • Death
  • MI
  • Stroke
  • Revascularization
Follow-up
Median 4.8 y (CLARIFY) and 4.9 y (SCOT-HEART)

Main finding

As reported in the abstract

MACE per unit increase in VCI (adjusted)
per unit increase in VCI
Adjusted HRP value
CLARIFY
1.12(95% CI 1.02–1.22)
P = 0.02
SCOT-HEART
1.16(CI 1.03–1.31)
P = 0.02

Per unit increase in VCI, as printed

Observational data: associations, not effects.

Further findings

OutcomeEstimateP value
MACE, top vs lowest quartile of adjusted model risk — CLARIFY · Q4 vs Q1HR 25.0P < 0.005
MACE, top vs lowest quartile of adjusted model risk — SCOT-HEART · Q4 vs Q1HR 33.7P < 0.005
Net reclassification index with VCI added to Agatston — CLARIFYNRI 0.52 (CI 0.40–0.64)P < 0.005
Net reclassification index with VCI added to Agatston — SCOT-HEARTNRI 0.72 (CI 0.48–0.94)P < 0.005

C-index, Agatston vs Agatston + vulnerable calcium index (VCI)

CLARIFY C-index 0.62 to 0.66
P < 0.001
SCOT-HEART C-index 0.72 to 0.75
P < 0.001

Coronary CT angiography (CCTA) high-risk plaque features (SCOT-HEART), adjusted for Agatston score

VCI associated with all high-risk plaque (HRP) features, OR
1.45 to 1.85
  • p<0.001

Original publication

Sub-Agatston coronary calcification on non-contrast cardiac CT and cardiovascular risk. Eur J Prev Cardiol. Published 1 June 2026. doi:10.1093/eurjpc/zwag285
Read the original article ↗PubMedCite RIS · BibTeX

Summarised from the published abstract; every number is checked against it