Prognostic significance of cardiac cinefluoroscopy for coronary calcific deposits in asymptomatic high risk subjects

Saint John's Cardiovascular Research Center, Torrance, California 90502-2064.

OBJECTIVES. This research investigated the prognostic significance of radiographically detectable coronary calcific deposits. BACKGROUND. Coronary calcific deposits are almost always associated with coronary atherosclerosis. We investigated the association between fluoroscopically determined coronary calcium and coronary heart disease end points at 1 year of follow-up. METHODS. This prospective population-based cohort study was conducted in the suburbs of Los Angeles. Fourteen hundred sixty-one asymptomatic adults with an estimated > or = 10% risk of having a coronary heart disease event within 8 years underwent cardiac cinefluoroscopy for assessment of coronary calcium at initiation of the study. Clinical status including angina, documented myocardial infarction, myocardial revascularization and death from coronary heart disease were determined after 1 year. RESULTS. The prevalence of calcific deposits was high (47%). A follow-up examination at 1 year was successfully completed in 99.9% of subjects. Six subjects (0.4%) had died from coronary heart disease and 9 (0.6%) had had a nonfatal myocardial infarction. Thirty-seven subjects (2.5%) reported angina pectoris, and 13 (0.9%) had undergone myocardial revascularization. Fifty-three subjects had at least one event during the 1-year period. Radiographically detectable calcium was associated with the presence of at least one of these end points, with a risk ratio of 2.7 (confidence limits 1.4, 4.6). The presence of coronary calcium was an independent predictor of at least one end point when controlling for age, gender and risk factors. However, three deaths due to coronary heart disease and two nonfatal myocardial infarctions occurred in subjects without detectable coronary calcium. CONCLUSIONS. The presence of coronary calcific deposits incurs an increased risk of coronary heart disease events in asymptomatic high risk subjects at 1 year. This increased risk is independent of that incurred by standard risk factors.

This article has been cited by other articles:

				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]

				L.-C. Chen, J.-W. Chen, M.-H. Wu, J.-C. Liu, G.-Y. Lan, P. Y.-A. Ding, and M.-S. Chang Differential Coronary Calcification on Electron-Beam CT Between Syndrome X and Coronary Artery Disease in Patients With Chronic Stable Angina Pectoris Chest, November 1, 2001; 120(5): 1525 - 1533. [Abstract] [Full Text] [PDF]

				L. C. Gallo, K. A. Matthews, L. H. Kuller, K. Sutton-Tyrrell, and D. Edmundowicz Educational Attainment and Coronary and Aortic Calcification in Postmenopausal Women Psychosom Med, November 1, 2001; 63(6): 925 - 935. [Abstract] [Full Text] [PDF]

				R. Haberl, A. Becker, A. Leber, A. Knez, C. Becker, C. Lang, R. Bruning, M. Reiser, and G. Steinbeck Correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: results of 1,764 patients J. Am. Coll. Cardiol., February 1, 2001; 37(2): 451 - 457. [Abstract] [Full Text] [PDF]

				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]

				A. P. Guerin, G. M. London, S. J. Marchais, and F. Metivier Arterial stiffening and vascular calcifications in end-stage renal disease Nephrol. Dial. Transplant., July 1, 2000; 15(7): 1014 - 1021. [Abstract] [Full Text] [PDF]

				U. Sechtem Electron beam computed tomography: on its way into mainstrem cardiology? Eur. Heart J., January 2, 2000; 21(2): 87 - 91. [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]

				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]

				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]

				S. L. R. Kardia, M. B. Haviland, R. E. Ferrell, and C. F. Sing The Relationship Between Risk Factor Levels and Presence of Coronary Artery Calcification is Dependent on Apolipoprotein E Genotype Arterioscler. Thromb. Vasc. Biol., February 1, 1999; 19(2): 427 - 435. [Abstract] [Full Text] [PDF]

				W. Stanford and B. H. Thompson Coronary atherosclerosis and its effect on cardiac structure and function: evaluation by electron beam computed tomography Clin. Chem., August 1, 1998; 44(8): 1871 - 1881. [Abstract] [Full Text] [PDF]

				T. M. Doherty, W. Tang, S. Dascalos, K. E. Watson, L. L. Demer, R. M. Shavelle, and R. C. Detrano Ethnic Origin and Serum Levels of 1{alpha},25-Dihydroxyvitamin D3 Are Independent Predictors of Coronary Calcium Mass Measured by Electron-Beam Computed Tomography Circulation, September 2, 1997; 96(5): 1477 - 1481. [Abstract] [Full Text]

				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]

				M. Balica, K. Bostrom, V. Shin, K. Tillisch, and L. L. Demer Calcifying Subpopulation of Bovine Aortic Smooth Muscle Cells Is Responsive to 17ß-Estradiol Circulation, April 1, 1997; 95(7): 1954 - 1960. [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]

				Y. Arad, L. A. Spadaro, K. Goodman, A. Lledo-Perez, S. Sherman, G. Lerner, and A. D. Guerci Predictive Value of Electron Beam Computed Tomography of the Coronary Arteries : 19-Month Follow-up of 1173 Asymptomatic Subjects Circulation, June 1, 1996; 93(11): 1951 - 1953. [Abstract] [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]

				M. J. Budoff, D. Georgiou, A. Brody, A. S. Agatston, J. Kennedy, C. Wolfkiel, W. Stanford, P. Shields, R. J. Lewis, W. R. Janowitz, et al. Ultrafast Computed Tomography as a Diagnostic Modality in the Detection of Coronary Artery Disease : A Multicenter Study Circulation, March 1, 1996; 93(5): 898 - 904. [Abstract] [Full Text]

				J. A. Rumberger, D. B. Simons, L. A. Fitzpatrick, P. F. Sheedy, and R. S. Schwartz Coronary Artery Calcium Area by Electron-Beam Computed Tomography and Coronary Atherosclerotic Plaque Area : A Histopathologic Correlative Study Circulation, October 15, 1995; 92(8): 2157 - 2162. [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]

				CORONARY CALCIFICATION: HOW GOOD A RISK FACTOR? Journal Watch (General), August 19, 1994; 1994(819): 6 - 6. [Full Text]