CLINICAL STUDIES
Independent and incremental value of coronary artery calcium for predicting the extent of angiographic coronary artery disease
Comparison with cardiac risk factors and radionuclide perfusion imaging
Axel Schmermund, MD*,
Ali E. Denktas, MD ,
John A. Rumberger, PhD, MD, FACC*,
Timothy F. Christian, MD, FACC*,
Patrick F. Sheedy, II, MD ,
Kent R. Bailey, PhD and
Robert S. Schwartz, MD, FACC*
* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, USA
Department of Diagnostic Radiology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
Section of Biostatistics, Mayo Clinic and Foundation, Rochester, Minnesota; USA
University of Texas–Houston Medical School, Department of Internal Medicine (Cardiology Division), Houston, Texas, USA
Manuscript received August 20, 1998;
revised manuscript received April 9, 1999,
accepted May 16, 1999.
Reprint requests and correspondence: Dr. Axel Schmermund, Department of Cardiology, University Clinic Essen, Hufelandstrasse 55, D-45122 Essen, Germany
Axel.Schmermund{at}uni-essen.de
OBJECTIVES
The study was done to test the ability to predict the extent of angiographically determined coronary artery disease (CAD) by quantification of coronary calcium using electron-beam computed tomography (EBCT) and to compare it with more conventional parameters for delineating the angiographic extent of CAD, that is, cardiovascular risk factors and radionuclide single-photon emission computed tomography (SPECT).
BACKGROUND
The angiographic extent of CAD is a powerful predictor of subsequent events. Use of EBCT may be able to define it by virtue of its ability to determine plaque burden.
METHODS
We examined 308 patients presenting with suspected but not previously known CAD who underwent selective coronary angiography. As measures of the angiographic extent of CAD, coronary artery greater even 20 (CAGE  20) and CAGE 50 scores represented the total number of coronary segments with 20% or 50% stenoses, respectively. The EBCT-derived total calcium scores were obtained in 291 patients, risk factors as defined by the National Cholesterol Education Program in 239 patients, and SPECT scans in 136 patients.
RESULTS
Using multiple linear regression analysis, total calcium scores were better independent predictors of both CAGE 20 and CAGE 50 scores than either a SPECT-derived radionuclide perfusion score or the risk factors age, male gender and ratio of total/high-density lipoprotein (HDL) cholesterol. The association between EBCT and angiographic scores remained highly significant after excluding the influence of all interrelated risk factors and SPECT variables (r = 0.65; p < 0.001 for CAGE 20 scores, r = 0.50; p < 0.001 for CAGE 50 scores).
CONCLUSIONS
Coronary calcium predicts the angiographic extent of CAD in symptomatic patients and provides independent and incremental information to the more conventional clinical parameters derived from SPECT or risk assessment.
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Abbreviations and Acronyms
| | BARI | = Bypass Angioplasty Revascularization Investigation | | CAD | = coronary artery disease | | CAGE 20 score | = coronary artery greater even than 20 score | | CAGE 50 score | = coronary artery greater even than 50 score | | CASS | = Coronary Artery Surgery Study | | CT | = computerized tomography | | EBCT | = electron-beam computed tomography | | ECC | = electrocardiogram | | HDL | = high-density lipoprotein | | LDL | = low-density lipoprotein | | NCEP | = National Cholesterol Education Program | | SPECT | = single-photon emission computed tomography |
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