Abstract 14704: Does Fluoroscopic Coronary Calcification Predict Future Major Adverse Cardiovascular Events Independent Of Other Risk Factors, Including Coronary Artery Disease Severity?
Background: The degree of coronary calcification has been used as a surrogate marker for severity of coronary artery disease. However, when measured by computed tomography, the severity of obstructive coronary atherosclerosis cannot often be determined. Whether severity of coronary artery calcification predicts adverse cardiovascular outcomes independent of traditional and other novel risk factors and the presence of obstructive (≥70% stenosis in at least one major vessel) coronary artery disease (CAD), remains unknown.
Methods: We characterized 1,139 consecutive patients (age=65.3±12.1 yrs; males=61.8%) undergoing clinically indicated angiography for CAD, fluoroscopic coronary calcification F-CAC), and outcomes. To assess angiographic severity of F-CAC, we developed a novel scoring system, reporting both extent (0-3) and severity (0-3) for each major coronary vessel. A global score for each individual patient was determined by multiplying extent and severity score for each vessel scored and adding all the scored vessels (range = 0-24; categorized into 4 levels of severity: 0 [n=735], 1-2 [n=119], 3-4 [n=75], ≥5 [n=105]). For this analysis, we examined the association of the presence of F-CAC (scores ≥1) and outcomes, stratified by the presence of CAD, and adjusted for confounding using multivariable analysis.
Results: Mean follow-up was 7.5±2.6 years. Among patients with CAD (n=694), F-CAC (n=282) was not associated with the risk of death (Hazard ratio [HR] = 1.24, p=0.10), myocardial infarction (MI) (HR=1.07, p=0.74), stroke (HR=1.11, p=0.73), revascularization (R) (HR=0.94, p=0.71) or the combination (MACE) (HR=1.03, p=0.80). However, among patients with no CAD (n=445), F-CAC (n=55) was significantly associated with over-all MACE (HR = 1.82, p=0.02) and showed strong individual trends for death (HR=1.61, p=0.11), MI (HR=2.30, p=0.18), stroke (HR=2.09, p=0.24) and R (HR=2.89, p=0.04).
Conclusions: In this cohort of patients undergoing coronary angiography, we found a stronger association between F-CAC and adverse cardiovascular events among those without, rather than with, obstructive CAD. This underscores the independent importance of coronary arterial calcification and the need for further study.
- © 2011 by American Heart Association, Inc.