(Circulation. 1999;99:2633-2638.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Coronary Calcium Does Not Accurately Predict Near-Term Future Coronary Events in High-Risk Adults
From the Division of Cardiology, Department of Medicine, Harbor-UCLA Medical Center, Torrance (R.C.D., T.M.D., W.T., L.E.G., M.J.B., K.A.N.); the Heart Disease Prevention Program, Department of Medicine, University of California, Irvine (N.D.W.); and the Department of Statistics, University of California, Riverside (R.M.S.), Calif.
Background—Prognostic risk models have had limited success in predicting coronary events in subjects with multiple risk factors. We and others have proposed an alternative approach using radiographically detectable coronary calcium. We evaluated and compared the predictive value of these 2 approaches for determining coronary event risk in asymptomatic adults with multiple coronary risk factors. In addition, we assessed the predictive value of a risk model that included calcium score and cardiac risk-factor data.
Methods and Results—We recruited 1196 asymptomatic high-coronary-risk subjects who then underwent risk-factor assessment and cardiac electron-beam CT (EBCT) scanning and were followed up for 41 months with a 99% success rate. We applied the Framingham model and our data-derived risk model to determine the 3-year likelihood of a coronary event. The mean age of our cohort was 66 years, and mean 3-year Framingham risk was 3.3±3.6%. Sixty-eight percent (818 subjects) had detectable coronary calcium. There were 17 coronary deaths (1.4%) and 29 nonfatal infarctions (2.4%). The receiver operating characteristic (ROC) curve areas calculated from the Framingham model, our data-derived risk model, and the calcium score were 0.69±0.05, 0.68±0.05, and 0.64±0.05, respectively (P=NS). When calcium score was included as a variable in the data-derived model, the ROC area did not change significantly (0.68±0.05 to 0.71±0.04; P=NS).
Conclusions—Neither risk-factor assessment nor EBCT calcium is an accurate event predictor in high-risk asymptomatic adults. EBCT calcium score does not add significant incremental information to risk factors, and its use in clinical screening is not justified at this time.
Key Words: risk factors • calcium • coronary disease • tomography
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Y. Arad, L. A. Spadaro, K. Goodman, D. Newstein, and A. D. Guerci Prediction of coronary events with electron beam computed tomography J. Am. Coll. Cardiol., October 1, 2000; 36(4): 1253 - 1260. [Abstract] [Full Text] [PDF]
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L. J. Shaw and R. A. O'Rourke The challenge of improving risk assessment in asymptomatic individuals: the additive prognostic value of electron beam tomography? J. Am. Coll. Cardiol., October 1, 2000; 36(4): 1261 - 1264. [Full Text] [PDF]
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L. F. Bielak, J. A. Rumberger, P. F. Sheedy II, R. S. Schwartz, and P. A. Peyser Probabilistic Model for Prediction of Angiographically Defined Obstructive Coronary Artery Disease Using Electron Beam Computed Tomography Calcium Score Strata Circulation, July 25, 2000; 102(4): 380 - 385. [Abstract] [Full Text] [PDF]
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W. R. Janowitz, R. C. Detrano, N. D. Wong, T. M. Doherty, R. M. Shavelle, W. Tang, L. E. Ginzton, M. J. Budoff, and K. A. Narahara Coronary Calcium Does Not Accurately Predict Near-Term Future Coronary Events in High-Risk Adults Response Circulation, July 11, 2000; 102 (2): e20 - e21. [Full Text] [PDF]
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R. A. O'Rourke, B. H. Brundage, V. F. Froelicher, P. Greenland, S. M. Grundy, R. Hachamovitch, G. M. Pohost, L. J. Shaw, W. S. Weintraub, W. L. Winters Jr, et al. American College of Cardiology/American Heart Association Expert Consensus Document on Electron-Beam Computed Tomography for the Diagnosis and Prognosis of Coronary Artery Disease : Committee Members Circulation, July 4, 2000; 102(1): 126 - 140. [Full Text] [PDF]
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R. F. Redberg, N. Rifai, L. Gee, and P. M. Ridker Lack of association of C-reactive protein and coronary calcium by electron beam computed tomography in postmenopausal women: implications for coronary artery disease screening J. Am. Coll. Cardiol., July 1, 2000; 36(1): 39 - 43. [Abstract] [Full Text] [PDF]
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R. A. O'Rourke, B. H. Brundage, V. F. Froelicher, P. Greenland, S. M. Grundy, R. Hachamovitch, G. M. Pohost, L. J. Shaw, W. S. Weintraub, W. L. Winters Jr, et al. American College of Cardiology/American Heart Association expert consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease J. Am. Coll. Cardiol., July 1, 2000; 36(1): 326 - 340. [Full Text] [PDF]
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C. Iribarren, S. Sidney, B. Sternfeld, and W. S. Browner Calcification of the Aortic Arch: Risk Factors and Association With Coronary Heart Disease, Stroke, and Peripheral Vascular Disease JAMA, June 7, 2000; 283(21): 2810 - 2815. [Abstract] [Full Text] [PDF]
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J. J. Carr, J. R. Crouse III, D. C. Goff Jr., R. B. D'Agostino Jr., N. P. Peterson, and G. L. Burke Evaluation of Subsecond Gated Helical CT for Quantification of Coronary Artery Calcium and Comparison with Electron Beam CT Am. J. Roentgenol., April 1, 2000; 174(4): 915 - 921. [Abstract] [Full Text] [PDF]
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A. J. Taylor, A. P. Burke, P. G. O’Malley, A. Farb, G. T. Malcom, J. Smialek, and R. Virmani A Comparison of the Framingham Risk Index, Coronary Artery Calcification, and Culprit Plaque Morphology in Sudden Cardiac Death Circulation, March 21, 2000; 101(11): 1243 - 1248. [Abstract] [Full Text] [PDF]
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P. Greenland, J. Abrams, G. P. Aurigemma, M. G. Bond, L. T. Clark, M. H. Criqui, J. R. Crouse III, L. Friedman, V. Fuster, D. M. Herrington, et al. Prevention Conference V : Beyond Secondary Prevention : Identifying the High-Risk Patient for Primary Prevention : Noninvasive Tests of Atherosclerotic Burden : Writing Group III Circulation, January 4, 2000; 101 (1): e16 - e22. [Full Text] [PDF]
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U. Sechtem Electron beam computed tomography: on its way into mainstrem cardiology? Eur. Heart J., January 2, 2000; 21(2): 87 - 91. [PDF]
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P. Libby and P. M. Ridker Novel Inflammatory Markers of Coronary Risk : Theory Versus Practice Circulation, September 14, 1999; 100(11): 1148 - 1150. [Full Text] [PDF]
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T. M. Doherty, W. Tang, and R. C. Detrano Racial differences in the significance of coronary calcium in asymptomatic black and white subjects with coronary risk factors J. Am. Coll. Cardiol., September 1, 1999; 34(3): 787 - 794. [Abstract] [Full Text] [PDF]
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 Coronary Calcium Not Predictive of Near-Term Coronary Events Journal Watch (General), June 8, 1999; 1999(608): 6 - 6. [Full Text]
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B. Pitt and M. Rubenfire Risk Stratification for the Detection of Preclinical Coronary Artery Disease Circulation, May 25, 1999; 99(20): 2610 - 2612. [Full Text] [PDF]
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