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J Am Coll Cardiol, 2000; 36:1253-1260
© 2000 by the American College of Cardiology Foundation
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CLINICAL STUDY: CORONARY ARTERY DISEASE

Prediction of coronary events with electron beam computed tomography

Yadon Arad, MD, FACC*, Louise A. Spadaro, MD, FACC*, Ken Goodman, MD{dagger}, David Newstein, MS* and Alan D. Guerci, MD, FACC*

* Department of Preventive Cardiology, St. Francis Hospital, Roslyn, New York, USA
{dagger} Department of Radiology, St. Francis Hospital, Roslyn, New York, USA

Manuscript received October 22, 1999; revised manuscript received March 7, 2000, accepted May 31, 2000.

Reprint requests and correspondence: Dr. Yadon Arad, Director of Preventive Cardiology, St. Francis Hospital, 100 Port Washington Boulevard, Roslyn, New York 11576
yadon{at}earthlink.net

OBJECTIVES

We sought to determine the prognostic accuracy of electron beam computed tomographic (EBCT) scanning of the coronary arteries at three to four years.

BACKGROUND

Coronary artery calcium scores determined by EBCT correlate with the severity of coronary artery disease. However, previous reports of the prognostic accuracy of EBCT scanning for coronary events in asymptomatic individuals are conflicting.

METHODS

Asymptomatic men and women undergoing coronary EBCT completed initial and follow-up evaluations, which included past medical history, the Rose angina questionnaire and interim cardiovascular events. Reported coronary events (death, nonfatal myocardial infarction [MI] and revascularization procedures) were confirmed without knowledge of the scan results.

RESULTS

Information was obtained in 1,172 (99.6%) of 1,177 eligible subjects (baseline age 53 ± 11 years, 71% men). During an average follow-up of 3.6 years, 39 subjects sustained coronary events: three coronary deaths, 15 nonfatal MIs and 21 coronary artery revascularization procedures. The mean coronary artery calcium score was 764 ± 935 among subjects with events as compared with 135 ± 432 among those without events (p < 0.0001). For the prediction of all coronary events and of nonfatal MIs and deaths, the areas under the receiver-operator characteristics curve were 0.84 and 0.86, respectively, and a coronary calcium score ≥160 was associated with odds ratios of 15.8 and 22.2, respectively. The odds ratios for all events remained high (14.3 to 20.2) after adjustment for self-reported cardiovascular risk factors.

CONCLUSIONS

In asymptomatic adults, EBCT of the coronary arteries predicts coronary death and nonfatal MI and the need for revascularization procedures.

Abbreviations and Acronyms
  CI = confidence interval
  EBCT = electron beam computed tomography
  MI = myocardial infarction
  OR = odds ratio
  ROC = receiver-operator characteristics




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 Am. J. Roentgenol.Home page
J. Horiguchi, H. Yamamoto, Y. Akiyama, N. Hirai, K. Marukawa, H. Fukuda, and K. Ito
Variability of Repeated Coronary Artery Calcium Measurements by 16-MDCT with Retrospective Reconstruction
Am. J. Roentgenol., June 1, 2005; 184(6): 1917 - 1923.
[Abstract] [Full Text] [PDF]

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 Psychosom. Med.Home page
W. J. Kop, D. S. Berman, H. Gransar, N. D. Wong, R. Miranda-Peats, M. D. White, M. Shin, M. Bruce, D. S. Krantz, and A. Rozanski
Social Network and Coronary Artery Calcification in Asymptomatic Individuals
Psychosom Med, May 1, 2005; 67(3): 343 - 352.
[Abstract] [Full Text] [PDF]

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 RadiologyHome page
J. C. Nelson, R. A. Kronmal, J. J. Carr, M. F. McNitt-Gray, N. D. Wong, C. M. Loria, J. G. Goldin, O. D. Williams, and R. Detrano
Measuring Coronary Calcium on CT Images Adjusted for Attenuation Differences
Radiology, May 1, 2005; 235(2): 403 - 414.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
A. E. Cassidy, L. F. Bielak, Y. Zhou, P. F. Sheedy II, S. T. Turner, J. F. Breen, P. A. Araoz, I. J. Kullo, X. Lin, and P. A. Peyser
Progression of Subclinical Coronary Atherosclerosis: Does Obesity Make a Difference?
Circulation, April 19, 2005; 111(15): 1877 - 1882.
[Abstract] [Full Text] [PDF]

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 CLIN APPL THROMB HEMOSTHome page
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]

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 CirculationHome page
D. E. Bild, R. Detrano, D. Peterson, A. Guerci, K. Liu, E. Shahar, P. Ouyang, S. Jackson, and M. F. Saad
Ethnic Differences in Coronary Calcification: The Multi-Ethnic Study of Atherosclerosis (MESA)
Circulation, March 15, 2005; 111(10): 1313 - 1320.
[Abstract] [Full Text] [PDF]

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 HeartHome page
N. R Mollet, F. Cademartiri, and P. J de Feyter
Non-invasive multislice CT coronary imaging
Heart, March 1, 2005; 91(3): 401 - 407.
[Full Text] [PDF]

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 CirculationHome page
J. H. Mieres, L. J. Shaw, A. Arai, M. J. Budoff, S. D. Flamm, W. G. Hundley, T. H. Marwick, L. Mosca, A. R. Patel, M. A. Quinones, et al.
Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Coronary Artery Disease: Consensus Statement From the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association
Circulation, February 8, 2005; 111(5): 682 - 696.
[Abstract] [Full Text] [PDF]

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 Arch Intern MedHome page
R. Vliegenthart, H.-H. S. Oei, A. P. M. van den Elzen, F. J. A. van Rooij, A. Hofman, M. Oudkerk, and J. C. M. Witteman
Alcohol Consumption and Coronary Calcification in a General Population
Arch Intern Med, November 22, 2004; 164(21): 2355 - 2360.
[Abstract] [Full Text] [PDF]

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 Circ. Res.Home page
M. Abedin, Y. Tintut, and L. L. Demer
Mesenchymal Stem Cells and the Artery Wall
Circ. Res., October 1, 2004; 95(7): 671 - 676.
[Abstract] [Full Text] [PDF]

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 Nephrol Dial TransplantHome page
A. A. Haydar, N. M. A. Hujairi, A. A. Covic, D. Pereira, M. Rubens, and D. J. A. Goldsmith
Coronary artery calcification is related to coronary atherosclerosis in chronic renal disease patients: a study comparing EBCT-generated coronary artery calcium scores and coronary angiography
Nephrol. Dial. Transplant., September 1, 2004; 19(9): 2307 - 2312.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
D. S. Berman, N. D. Wong, H. Gransar, R. Miranda-Peats, J. Dahlbeck, S. W. Hayes, J. D. Friedman, X. Kang, D. Polk, R. Hachamovitch, et al.
Relationship between stress-induced myocardial ischemia and atherosclerosis measured by coronary calcium tomography
J. Am. Coll. Cardiol., August 18, 2004; 44(4): 923 - 930.
[Abstract] [Full Text] [PDF]

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 Arterioscler. Thromb. Vasc. Bio.Home page
M. Abedin, Y. Tintut, and L. L. Demer
Vascular Calcification: Mechanisms and Clinical Ramifications
Arterioscler Thromb Vasc Biol, July 1, 2004; 24(7): 1161 - 1170.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
G. B. J. Mancini, B. Dahlof, and J. Diez
Surrogate Markers for Cardiovascular Disease: Structural Markers
Circulation, June 29, 2004; 109(25_suppl_1): IV-22 - IV-30.
[Full Text] [PDF]

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 Arch Intern MedHome page
M. J. Pletcher, J. A. Tice, M. Pignone, and W. S. Browner
Using the Coronary Artery Calcium Score to Predict Coronary Heart Disease Events: A Systematic Review and Meta-analysis
Arch Intern Med, June 28, 2004; 164(12): 1285 - 1292.
[Abstract] [Full Text] [PDF]

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 Am. J. Roentgenol.Home page
J. E. Hokanson, T. MacKenzie, G. Kinney, J. K. Snell-Bergeon, D. Dabelea, J. Ehrlich, R. H. Eckel, and M. Rewers
Evaluating Changes in Coronary Artery Calcium: An Analytic Method That Accounts for Interscan Variability
Am. J. Roentgenol., May 1, 2004; 182(5): 1327 - 1332.
[Abstract] [Full Text] [PDF]

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 JAMAHome page
M. J. Budoff, J. Ehrlich, H. S. Hecht, and J. A. Rumberger
Use of Coronary Calcification Scores to Predict Coronary Heart Disease
JAMA, April 21, 2004; 291(15): 1832 - 1832.
[Full Text] [PDF]

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 CirculationHome page
M. Fornage, E. Boerwinkle, P. A. Doris, D. Jacobs, K. Liu, and N. D. Wong
Polymorphism of the Soluble Epoxide Hydrolase Is Associated With Coronary Artery Calcification in African-American Subjects: The Coronary Artery Risk Development In Young Adults (CARDIA) Study
Circulation, January 27, 2004; 109(3): 335 - 339.
[Abstract] [Full Text] [PDF]

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 JAMAHome page
P. Greenland, L. LaBree, S. P. Azen, T. M. Doherty, and R. C. Detrano
Coronary Artery Calcium Score Combined With Framingham Score for Risk Prediction in Asymptomatic Individuals
JAMA, January 14, 2004; 291(2): 210 - 215.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
J. Zhu, R. J. Katz, A. A. Quyyumi, D. A. Canos, D. Rott, G. Csako, A. Zalles-Ganley, J. Ogunmakinwa, A. G. Wasserman, and S. E. Epstein
Association of Serum Antibodies to Heat-Shock Protein 65 With Coronary Calcification Levels: Suggestion of Pathogen-Triggered Autoimmunity in Early Atherosclerosis
Circulation, January 6, 2004; 109(1): 36 - 41.
[Abstract] [Full Text] [PDF]

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 NEJMHome page
Y. Asanuma, A. Oeser, A. K. Shintani, E. Turner, N. Olsen, S. Fazio, M. F. Linton, P. Raggi, and C. M. Stein
Premature Coronary-Artery Atherosclerosis in Systemic Lupus Erythematosus
N. Engl. J. Med., December 18, 2003; 349(25): 2407 - 2415.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
M. J. Budoff, S. Achenbach, and A. Duerinckx
Clinical utility of computed tomography and magnetic resonance techniques for noninvasive coronary angiography
J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1867 - 1878.
[Abstract] [Full Text] [PDF]

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 J Am Board Fam MedHome page
J. J. Fenton and R. A. Deyo
Patient Self-Referral for Radiologic Screening Tests: Clinical and Ethical Concerns
J Am Board Fam Med, November 1, 2003; 16(6): 494 - 501.
[Abstract] [Full Text] [PDF]

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 DiabetesHome page
D. Dabelea, G. Kinney, J. K. Snell-Bergeon, J. E. Hokanson, R. H. Eckel, J. Ehrlich, S. Garg, R. F. Hamman, and M. Rewers
Effect of Type 1 Diabetes on the Gender Difference in Coronary Artery Calcification: a Role for Insulin Resistance?: The Coronary Artery Calcification in Type 1 Diabetes (CACTI) Study
Diabetes, November 1, 2003; 52(11): 2833 - 2839.
[Abstract] [Full Text] [PDF]

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 RadiologyHome page
R. Vliegenthart, B. Song, A. Hofman, J. C. M. Witteman, and M. Oudkerk
Coronary Calcification at Electron-Beam CT: Effect of Section Thickness on Calcium Scoring in Vitro and in Vivo
Radiology, November 1, 2003; 229(2): 520 - 525.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
M. Naghavi, P. Libby, E. Falk, S. W. Casscells, S. Litovsky, J. Rumberger, J. J. Badimon, C. Stefanadis, P. Moreno, G. Pasterkamp, et al.
From Vulnerable Plaque to Vulnerable Patient: A Call for New Definitions and Risk Assessment Strategies: Part II
Circulation, October 14, 2003; 108(15): 1772 - 1778.
[Abstract] [Full Text] [PDF]

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 Arterioscler. Thromb. Vasc. Bio.Home page
M. P. Reilly, M. L. Wolfe, A. R. Localio, and D. J. Rader
C-Reactive Protein and Coronary Artery Calcification: The Study of Inherited Risk of Coronary Atherosclerosis (SIRCA)
Arterioscler Thromb Vasc Biol, October 1, 2003; 23(10): 1851 - 1856.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
J. J. Fenton
Screening for Coronary Calcification
JAMA, September 24, 2003; 290(12): 1576 - 1577.
[Full Text] [PDF]


 
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