Circulation. 2001;104:412-417
doi: 10.1161/hc2901.093112
doi: 10.1161/hc2901.093112
(Circulation. 2001;104:412.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Long-Term Prognostic Value of Coronary Calcification Detected by Electron-Beam Computed Tomography in Patients Undergoing Coronary Angiography
From the Division of Cardiovascular Diseases (P.C.K., K.A., A.E.D., J.A.R., R.S.S.) and Diagnostic Radiology (P.F.S.), Mayo Clinic, Rochester, Minn, and Department of Epidemiology (L.F.B., L.S.J., P.A.P.), University of Michigan, Ann Arbor, Mich. Dr Rumberger is currently Professor of Medicine in the Department of Cardiology, Ohio State University, Columbus.
Correspondence to Robert S. Schwartz, MD, FACC, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905. E-mail schwartzr{at}mayo.edu
Background— Electron-beam CT (EBCT) quantification of coronary artery calcification (CAC) allows noninvasive assessment of coronary atherosclerosis. We undertook a follow-up study to determine whether CAC extent, measured at the time of angiography by EBCT, predicted future hard cardiac events, comprising cardiac death and nonfatal myocardial infarction (MI). We also assessed the potential of selected coronary artery disease (CAD) risk factors, prior CAD event history (MI or revascularization), and angiographic findings (number of diseased vessels and overall disease burden) to predict subsequent hard events.
Methods and Results— Two hundred eighty-eight patients who underwent contemporaneous coronary angiography and EBCT scanning were contacted after a mean of 6.9 years. Vital status and history of MI during follow-up were determined. Cox proportional hazards models were used to compare the predictive ability of CAC extent with selected CAD risk factors, CAD event history, and angiographic findings. Median CAC score was 160 (range 0 to 7633). The 22 patients who experienced hard events during follow-up were older and had more extensive CAC and angiographic disease (P<0.05). Only 1 of 87 patients with CAC score <20 experienced a subsequent hard event during follow-up. Event-free survival was significantly higher for patients with CAC scores <100 than for those with scores 
100 (relative risk 3.20; 95% CI 1.17 to 8.71). When a stepwise multivariable model was used, only age and CAC extent predicted hard events (risk ratios 1.72 and 1.88, respectively; P<0.05).
Conclusions— In patients undergoing angiography, CAC extent on EBCT is highly predictive of future hard cardiac events and adds valuable prognostic information.
Key Words: angiography • calcium • coronary disease • imaging • prognosis
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|
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|
|
|
|
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|
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|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
 U. Hoffmann, D. C. Kwait, J. Handwerker, R. Chan, G. Lamuraglia, and T. J. Brady Vascular Calcification in ex Vivo Carotid Specimens: Precision and Accuracy of Measurements with Multi-Detector Row CT Radiology, November 1, 2003; 229(2): 375 - 381. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
A. Y.-M. Wang, M. Wang, J. Woo, C. W.-K. Lam, P. K.-T. Li, S.-F. Lui, and J. E. Sanderson Cardiac Valve Calcification as an Important Predictor for All-Cause Mortality and Cardiovascular Mortality in Long-Term Peritoneal Dialysis Patients: A Prospective Study J. Am. Soc. Nephrol., January 1, 2003; 14(1): 159 - 168. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. J. Schoen and R. F. Padera Jr. Cardiac Surgical Pathology Card. Surg. Adult, January 1, 2003; 2(2003): 119 - 185. [Full Text]
|
|
|
|
|
|
C. Daly, P. Saravanan, and K. Fox Is calcium the clue? Eur. Heart J., October 2, 2002; 23(20): 1562 - 1566. [Full Text] [PDF]
|
|
|
|
|
|
A. B. Newman, B. L. Naydeck, K. Sutton-Tyrrell, D. Edmundowicz, D. O'Leary, R. Kronmal, G. L. Burke, and L. H. Kuller Relationship Between Coronary Artery Calcification and Other Measures of Subclinical Cardiovascular Disease in Older Adults Arterioscler. Thromb. Vasc. Biol., October 1, 2002; 22(10): 1674 - 1679. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Erbell, T. Budde, G. Kerkhoff, S. Mohlenkamp, and A. Schmermund Understanding the pathophysiology of the arterial wall: which method should we choose? Electron beam computed tomography Eur. Heart J. Suppl., September 1, 2002; 4(suppl_F): F47 - F53. [Abstract] [PDF]
|
|
|
|
 |
|
 L. L Demer Vascular calcification and osteoporosis: inflammatory responses to oxidized lipids Int. J. Epidemiol., August 1, 2002; 31(4): 737 - 741. [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
J. E. Hokanson, S. Cheng, J. K. Snell-Bergeon, B. A. Fijal, M. A. Grow, C. Hung, H. A. Erlich, J. Ehrlich, R. H. Eckel, and M. Rewers A Common Promoter Polymorphism in the Hepatic Lipase Gene (LIPC-480C>T) Is Associated With an Increase in Coronary Calcification in Type 1 Diabetes Diabetes, April 1, 2002; 51(4): 1208 - 1213. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Tintut, J. Patel, M. Territo, T. Saini, F. Parhami, and L. L. Demer Monocyte/Macrophage Regulation of Vascular Calcification In Vitro Circulation, February 5, 2002; 105(5): 650 - 655. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Weiss Another Calcium Paradox? Arterioscler. Thromb. Vasc. Biol., October 1, 2001; 21(10): 1561 - 1562. [Full Text] [PDF]
|
|