Cardiovasc Imaging Asia.  2021 Jul;5(3):63-71. 10.22468/cvia.2021.00038.

Prognostic Value of Coronary Artery Calcium in a Multi-Ethnic Asian Cohort

  • 1Department of Cardiology, National Heart Centre Singapore, Singapore
  • 2Duke-NUS Medical School, Singapore
  • 3Department of Cardiac Radiology, National Heart Centre Singapore, Singapore


Coronary artery calcium (CAC) is associated with the presence of coronary atherosclerotic plaque and is a prognostic factor of cardiovascular events. CAC varies among ethnic groups in patients of the same age and gender. Studies on the prognostic value of CAC in a multi-ethnic Asian population have yet to be performed. We aim to study the association of CAC and ethnicity, all-cause mortality, and acute myocardial infarction (AMI).
Materials and Methods
This is a retrospective study with a multi-ethnic cohort aged 35–84 years from a single tertiary institution between 2007–2017. The individuals were all clinically referred for cardiac CT calcium scanning. CAC was determined by Toshiba Aquilion One 320 Multi-detector Row CT (Toshiba Medical System).
This study had 65% males at an average age of 55 years. In our multivariable analysis of 16561 individuals, CAC is generally higher in the Malay than Chinese ethnic group [odds ratio (OR)=1.30, 95% confidence interval (CI)=1.10–1.55] and did not differ among Indians and Chinese (p=0.400). Increasing CAC was associated with higher all-cause mortality (OR=1.27, 95% CI=1.17–1.36) and AMI (OR=1.50, 95% CI=1.35–1.66) after adjusting for known cardiovascular risk factors. Incorporation of CAC into a model with known cardiovascular risk variables enhanced prediction of all-cause mortality [area under the curve (AUC)= 0.78] and AMI (AUC=0.85).
This study is the largest performed in a multi-ethnic Asian cohort. Malay ethnicity seems to confer a higher likelihood of coronary calcification compared to the Chinese and Indians. CAC was associated with higher all-cause mortality and AMI and complemented traditional cardiovascular risk factors in risk prediction, confirming its applicability in a multi-ethnic Asian population


Coronary artery; Calcium; Prognosis; Ethnic; Asian
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