| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2000;101:1243.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
A Comparison of the Framingham Risk Index, Coronary Artery Calcification, and Culprit Plaque Morphology in Sudden Cardiac Death
From the Departments of Cardiology (A.J.T.) and General Internal Medicine (P.G.O.), Walter Reed Army Medical Center, Washington, DC; Louisiana State University Medical Center (G.T.M.), New Orleans, La; the Department of Pathology (J.S.), University of Maryland, Baltimore; and the Cardiovascular Division (A.P.B., A.F., R.V.), Armed Forces Institute of Pathology, Washington, DC.
Correspondence to Renu Virmani, MD, Chairperson, Cardiovascular Division, Armed Forces Institute of Pathology, 14th Street and Alaska Avenue, NW, Washington, DC 20307. E-mail virmani{at}afip.osd.mil
Background—Neither clinical prediction models nor noninvasive imaging tests that detect coronary artery calcification identify all patients who experience acute coronary events. Variations in culprit plaque morphology may account for these inaccuracies.
Methods and Results—We compared the 10-year Framingham risk
index, histologic coronary calcification, and culprit plaque
morphology in 79 consecutive adults with sudden cardiac death. There
was a modest relationship between the Framingham risk index and the
extent of histologic coronary calcification
(r=0.35, P=0.002). Agreement in risk
classification between the histologic calcification score and the
Framingham risk index occurred in 50 of 79 cases (63.3%,
P=0.039). Either a focus of coronary artery
calcification 
40 µmol/L (62% of cases) or a Framingham risk
index score average risk for age (62% of cases) were
present in 66 of 79 (83.5%) cases. Cases with plaque erosion
(n=22) had significantly less coronary calcification
(P=0.003) and lower Framingham risk index
(P=0.001) scores than stable (n=27) or ruptured (n=30)
plaques. Fourteen of 22 (63.6%) cases of plaque erosion were
classified as low risk by both the Framingham risk index and the
histologic calcification score.
Conclusions—The prediction of sudden cardiac death using the Framingham risk index and the measurement of coronary calcification are distinct methods of assessing risk for sudden cardiac death. Excessive reliance on either method alone will produce errors in risk classification, particularly for patients at risk of plaque erosion, but their combination may be complementary.
Key Words: death, sudden • risk factors • atherosclerosis • prognosis • calcification
This article has been cited by other articles:
 |
|
 |
|
  A. Zarjou, V. Jeney, P. Arosio, M. Poli, P. Antal-Szalmas, A. Agarwal, G. Balla, and J. Balla Ferritin Prevents Calcification and Osteoblastic Differentiation of Vascular Smooth Muscle Cells J. Am. Soc. Nephrol., June 1, 2009; 20(6): 1254 - 1263. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Y. Speer, H.-Y. Yang, T. Brabb, E. Leaf, A. Look, W.-L. Lin, A. Frutkin, D. Dichek, and C. M. Giachelli Smooth Muscle Cells Give Rise to Osteochondrogenic Precursors and Chondrocytes in Calcifying Arteries Circ. Res., March 27, 2009; 104(6): 733 - 741. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Kaul and P. S. Douglas Atherosclerosis Imaging: Prognostically Useful or Merely More of What We Know? Circ Cardiovasc Imaging, March 1, 2009; 2(2): 150 - 160. [Full Text] [PDF]
|
|
|
|
 |
|
 K. M. Johnson, D. A. Dowe, and J. A. Brink Traditional Clinical Risk Assessment Tools Do Not Accurately Predict Coronary Atherosclerotic Plaque Burden: A CT Angiography Study Am. J. Roentgenol., January 1, 2009; 192(1): 235 - 243. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Eckardt, G&#x.;n. Breithardt, and S. Hohnloser CHAPTER 30 Ventricular Tachycardia and Sudden Cardiac Death ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. M. Biasucci, M. Leo, and G. L. De Maria Local and Systemic Mechanisms of Plaque Rupture Angiology, August 1, 2008; 59(2_suppl): 73S - 76S. [Abstract] [PDF]
|
|
|
|
 |
|
 S. Norja, L. Nuutila, P. J Karhunen, and S. Goebeler C-reactive protein in vulnerable coronary plaques J. Clin. Pathol., May 1, 2007; 60(5): 545 - 548. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. S. Kaikkonen, M.-L. Kortelainen, E. Linna, and H. V. Huikuri Family History and the Risk of Sudden Cardiac Death as a Manifestation of an Acute Coronary Event Circulation, October 3, 2006; 114(14): 1462 - 1467. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Crouse III Thematic review series: Patient-Oriented Research. Imaging atherosclerosis: state of the art J. Lipid Res., August 1, 2006; 47(8): 1677 - 1699. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Nasu, E. Tsuchikane, O. Katoh, D. G. Vince, R. Virmani, J.-F. Surmely, A. Murata, Y. Takeda, T. Ito, M. Ehara, et al. Accuracy of In Vivo Coronary Plaque Morphology Assessment: A Validation Study of In Vivo Virtual Histology Compared With In Vitro Histopathology J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2405 - 2412. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Whooley Mind your heart. Ann Intern Med, June 6, 2006; 144(11): 858 - 860. [Full Text] [PDF]
|
|
|
|
|
|
D. Dey, T. Callister, P. Slomka, F. Aboul-Enein, H. Nishina, X. Kang, H. Gransar, N. D. Wong, R. Miranda-Peats, S. Hayes, et al. Computer-Aided Detection and Evaluation of Lipid-Rich Plaque on Noncontrast Cardiac CT Am. J. Roentgenol., June 1, 2006; 186(6_Supplement_2): S407 - S413. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Khera, J. A. de Lemos, R. M. Peshock, H. S. Lo, H. G. Stanek, S. A. Murphy, F. H. Wians Jr, S. M. Grundy, and D. K. McGuire Relationship Between C-Reactive Protein and Subclinical Atherosclerosis: The Dallas Heart Study Circulation, January 3, 2006; 113(1): 38 - 43. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Imoto, T. Hiro, T. Fujii, A. Murashige, Y. Fukumoto, G. Hashimoto, T. Okamura, J. Yamada, K. Mori, and M. Matsuzaki Longitudinal Structural Determinants of Atherosclerotic Plaque Vulnerability: A Computational Analysis of Stress Distribution Using Vessel Models and Three-Dimensional Intravascular Ultrasound Imaging J. Am. Coll. Cardiol., October 18, 2005; 46(8): 1507 - 1515. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Rzewuska-Lech, M. Jayachandran, L. A. Fitzpatrick, and V. M. Miller Differential effects of 17{beta}-estradiol and raloxifene on VSMC phenotype and expression of osteoblast-associated proteins Am J Physiol Endocrinol Metab, July 1, 2005; 289(1): E105 - E112. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. Giachelli Vascular Calcification: In Vitro Evidence for the Role of Inorganic Phosphate J. Am. Soc. Nephrol., September 1, 2003; 14(90004): S300 - 304. [Abstract] [Full Text]
|
|
|
|
 |
|
 K Pohle, D Ropers, R Maffert, P Geitner, W Moshage, M Regenfus, M Kusus, W G Daniel, and S Achenbach Coronary calcifications in young patients with first, unheralded myocardial infarction: a risk factor matched analysis by electron beam tomography Heart, June 1, 2003; 89(6): 625 - 628. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Y. Speer, M. D. McKee, R. E. Guldberg, L. Liaw, H.-Y. Yang, E. Tung, G. Karsenty, and C. M. Giachelli Inactivation of the Osteopontin Gene Enhances Vascular Calcification of Matrix Gla Protein-deficient Mice: Evidence for Osteopontin as an Inducible Inhibitor of Vascular Calcification In Vivo J. Exp. Med., October 21, 2002; 196(8): 1047 - 1055. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. J. Blake and P. M. Ridker C-Reactive Protein, Subclinical Atherosclerosis, and Risk of Cardiovascular Events Arterioscler Thromb Vasc Biol, October 1, 2002; 22(10): 1512 - 1513. [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]
|
|
|
|
 |
|
 R. C. Christian, S. Harrington, W. D. Edwards, A. L. Oberg, and L. A. Fitzpatrick Estrogen Status Correlates with the Calcium Content of Coronary Atherosclerotic Plaques in Women J. Clin. Endocrinol. Metab., March 1, 2002; 87(3): 1062 - 1067. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. B. Newman, B. L. Naydeck, J. Whittle, K. Sutton-Tyrrell, D. Edmundowicz, and L. H. Kuller Racial Differences in Coronary Artery Calcification in Older Adults Arterioscler Thromb Vasc Biol, March 1, 2002; 22(3): 424 - 430. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P J de Feyter and K Nieman New coronary imaging techniques: what to expect? Heart, March 1, 2002; 87(3): 195 - 197. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Zhang, M.-L. Brennan, X. Fu, R. J. Aviles, G. L. Pearce, M. S. Penn, E. J. Topol, D. L. Sprecher, and S. L. Hazen Association Between Myeloperoxidase Levels and Risk of Coronary Artery Disease JAMA, November 7, 2001; 286(17): 2136 - 2142. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Schmermund and R. Erbel Unstable Coronary Plaque and Its Relation to Coronary Calcium Circulation, October 2, 2001; 104(14): 1682 - 1687. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Weiss Another Calcium Paradox? Arterioscler Thromb Vasc Biol, October 1, 2001; 21(10): 1561 - 1562. [Full Text] [PDF]
|
|
|
|
|
|
J. A. Beckman, J. Ganz, M. A. Creager, P. Ganz, and S. Kinlay Relationship of Clinical Presentation and Calcification of Culprit Coronary Artery Stenoses Arterioscler Thromb Vasc Biol, October 1, 2001; 21(10): 1618 - 1622. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Huang, R. Virmani, H. Younis, A. P. Burke, R. D. Kamm, and R. T. Lee The Impact of Calcification on the Biomechanical Stability of Atherosclerotic Plaques Circulation, February 27, 2001; 103(8): 1051 - 1056. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
M. Janabi, S. Yamashita, K.-i. Hirano, N. Sakai, H. Hiraoka, K. Matsumoto, Z. Zhang, S. Nozaki, and Y. Matsuzawa Oxidized LDL-Induced NF-{kappa}B Activation and Subsequent Expression of Proinflammatory Genes Are Defective in Monocyte-Derived Macrophages From CD36-Deficient Patients Arterioscler Thromb Vasc Biol, August 1, 2000; 20(8): 1953 - 1960. [Abstract] [Full Text] [PDF]
|
|