Fluoroscopic coronary artery calcification and associated coronary disease in asymptomatic young men

Clinical Sciences Division, U.S. Air Force School of Aerospace Medicine, Brooks Air Force Base, San Antonio, Texas.

Little is known about the diagnostic significance of coronary artery calcification detected fluoroscopically in apparently healthy young men. This study compared the presence of fluoroscopically detected coronary artery calcification with angiographic coronary artery disease in asymptomatic male military aircrew undergoing noninvasive cardiac screening tests and coronary arteriography for occupational indications. Of 1,466 men screened with coronary fluoroscopy, 613 underwent coronary arteriography because of one or more abnormal noninvasive test results. The mean age (+/- SD) of all subjects screened was 40.2 +/- 5 years (range 26 to 65). Significant coronary artery disease (greater than or equal to 50% diameter stenosis) was found in 104 of the 613 subjects with arteriograms (16.9% disease prevalence). Overall sensitivity and specificity for coronary artery calcification detection of significant disease, based only on those subjects undergoing arteriography, were 66.3% and 77.6%, respectively. For measurable disease (mild plus significant), sensitivity was 60.6% and specificity 85.9%. Positive and negative predictive values were 37.7% and 91.9%, respectively, for significant disease. For measurable disease, positive and negative predictive values were 68.9% and 80.9%, respectively. In these asymptomatic young men, a fluoroscopic examination negative for coronary artery calcification indicated a low risk of significant coronary artery disease, whereas a positive test result (calcification present) substantially increased the likelihood of angiographically significant coronary artery disease.

This article has been cited by other articles:

				L. J. Schurgers, K. J.F. Teunissen, M. H.J. Knapen, M. Kwaijtaal, R. van Diest, A. Appels, C. P. Reutelingsperger, J. P.M. Cleutjens, and C. Vermeer Novel Conformation-Specific Antibodies Against Matrix {gamma}-Carboxyglutamic Acid (Gla) Protein: Undercarboxylated Matrix Gla Protein as Marker for Vascular Calcification Arterioscler. Thromb. Vasc. Biol., August 1, 2005; 25(8): 1629 - 1633. [Abstract] [Full Text] [PDF]

				C. M. Giachelli, M. Y. Speer, X. Li, R. M. Rajachar, and H. Yang Regulation of Vascular Calcification: Roles of Phosphate and Osteopontin Circ. Res., April 15, 2005; 96(7): 717 - 722. [Abstract] [Full Text] [PDF]

				F. Kushiya, H. Wada, M. Sakakura, Y. Mori, E. C. Gabazza, M. Nishikawa, T. Nobori, M. Noguchi, K. Izumi, T. Nakasaki, et al. Prognostic Impact of Aortic Calcification Index and Ankle-Arm Blood Pressure Indexin Patients under Hemodialysis Clinical and Applied Thrombosis/Hemostasis, April 1, 2005; 11(2): 161 - 169. [Abstract] [PDF]

				C. M. Giachelli Vascular Calcification Mechanisms J. Am. Soc. Nephrol., December 1, 2004; 15(12): 2959 - 2964. [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]

				S. A. Steitz, M. Y. Speer, M. D. McKee, L. Liaw, M. Almeida, H. Yang, and C. M. Giachelli Osteopontin Inhibits Mineral Deposition and Promotes Regression of Ectopic Calcification Am. J. Pathol., December 1, 2002; 161(6): 2035 - 2046. [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]

				S.-M. Herrmann, C. Whatling, E. Brand, V. Nicaud, J. Gariepy, A. Simon, A. Evans, J.-B. Ruidavets, D. Arveiler, G. Luc, et al. Polymorphisms of the Human Matrix Gla Protein (MGP) Gene, Vascular Calcification, and Myocardial Infarction Arterioscler. Thromb. Vasc. Biol., November 1, 2000; 20(11): 2386 - 2393. [Abstract] [Full Text] [PDF]

				S. Jono, M. D. McKee, C. E. Murry, A. Shioi, Y. Nishizawa, K. Mori, H. Morii, and C. M. Giachelli Phosphate Regulation of Vascular Smooth Muscle Cell Calcification Circ. Res., September 29, 2000; 87 (7): e10 - e17. [Abstract] [Full Text] [PDF]

				R Erbel, A Schmermund, S Mohlenkamp, S Sack, and D Baumgart Electron-beam computed tomography for detection of early signs of coronary arteriosclerosis Eur. Heart J., May 1, 2000; 21(9): 720 - 732. [PDF]

				C. M. Shanahan, N. R. B. Cary, J. R. Salisbury, D. Proudfoot, P. L. Weissberg, and M. E. Edmonds Medial Localization of Mineralization-Regulating Proteins in Association With Monckeberg’s Sclerosis : Evidence for Smooth Muscle Cell-Mediated Vascular Calcification Circulation, November 23, 1999; 100(21): 2168 - 2176. [Abstract] [Full Text] [PDF]

				W. Stanford Opening Plenary Session: 1998 : Coronary Artery Calcification as an Indicator of Preclinical Coronary Artery Disease RadioGraphics, November 1, 1999; 19(6): 1409 - 1419. [Full Text] [PDF]

				C. M. Giachelli Ectopic Calcification : Gathering Hard Facts about Soft Tissue Mineralization Am. J. Pathol., March 1, 1999; 154(3): 671 - 675. [Full Text] [PDF]

				T. Wada, M. D. McKee, S. Steitz, and C. M. Giachelli Calcification of Vascular Smooth Muscle Cell Cultures : Inhibition by Osteopontin Circ. Res., February 5, 1999; 84(2): 166 - 178. [Abstract] [Full Text] [PDF]

				A. Secci, N. Wong, W. Tang, S. Wang, T. Doherty, and R. Detrano Electron Beam Computed Tomographic Coronary Calcium as a Predictor of Coronary Events : Comparison of Two Protocols Circulation, August 19, 1997; 96(4): 1122 - 1129. [Abstract] [Full Text]

				J. Levenson, P. Giral, J. L. Megnien, J. Gariepy, M.-C. Plainfosse, and A. Simon Fibrinogen and Its Relations to Subclinical Extracoronary and Coronary Atherosclerosis in Hypercholesterolemic Men Arterioscler. Thromb. Vasc. Biol., January 1, 1997; 17(1): 45 - 50. [Abstract] [Full Text]

				L. Wexler, B. Brundage, J. Crouse, R. Detrano, V. Fuster, J. Maddahi, J. Rumberger, W. Stanford, R. White, and K. Taubert Coronary Artery Calcification: Pathophysiology, Epidemiology, Imaging Methods, and Clinical Implications: A Statement for Health Professionals From the American Heart Association Circulation, September 1, 1996; 94(5): 1175 - 1192. [Full Text]

				J. L. Megnien, A. Simon, M. Lemariey, M. C. Plainfosse, and J. Levenson Hypertension Promotes Coronary Calcium Deposit in Asymptomatic Men Hypertension, April 1, 1996; 27(4): 949 - 954. [Abstract] [Full Text]

				A. Shioi, Y. Nishizawa, S. Jono, H. Koyama, M. Hosoi, and H. Morii ß-Glycerophosphate Accelerates Calcification in Cultured Bovine Vascular Smooth Muscle Cells Arterioscler. Thromb. Vasc. Biol., November 1, 1995; 15(11): 2003 - 2009. [Abstract] [Full Text]

				A. Simon, P. Giral, and J. Levenson Extracoronary Atherosclerotic Plaque at Multiple Sites and Total Coronary Calcification Deposit in Asymptomatic Men : Association With Coronary Risk Profile Circulation, September 15, 1995; 92(6): 1414 - 1421. [Abstract] [Full Text]

				N. D. Wong, R. C. Detrano, D. Abrahamson, J. M. Tobis, and J. M. Gardin Coronary Artery Screening by Electron Beam Computed Tomography : Facts, Controversy, and Future Circulation, August 1, 1995; 92(3): 632 - 636. [Full Text]

				G. S. Mintz, J. J. Popma, A. D. Pichard, K. M. Kent, L. F. Satler, Y. C. Chuang, C. J. Ditrano, and M. B. Leon Patterns of Calcification in Coronary Artery Disease : A Statistical Analysis of Intravascular Ultrasound and Coronary Angiography in 1155 Lesions Circulation, April 1, 1995; 91(7): 1959 - 1965. [Abstract] [Full Text]

				FLUOROSCOPIC CORONARY CALCIFICATION AS A MARKER FOR CORONARY DISEASE Journal Watch (General), May 15, 1992; 1992(515): 6 - 6. [Full Text]

				S. Jono, C. Peinado, and C. M. Giachelli Phosphorylation of Osteopontin Is Required for Inhibition of Vascular Smooth Muscle Cell Calcification J. Biol. Chem., June 23, 2000; 275(26): 20197 - 20203. [Abstract] [Full Text] [PDF]

				S. A. Steitz, M. Y. Speer, G. Curinga, H.-Y. Yang, P. Haynes, R. Aebersold, T. Schinke, G. Karsenty, and C. M. Giachelli Smooth Muscle Cell Phenotypic Transition Associated With Calcification: Upregulation of Cbfa1 and Downregulation of Smooth Muscle Lineage Markers Circ. Res., December 7, 2001; 89(12): 1147 - 1154. [Abstract] [Full Text] [PDF]