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2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery
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J Am Coll Cardiol, 2005; 46:158-165, doi:10.1016/j.jacc.2005.02.088
© 2005 by the American College of Cardiology Foundation
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EXPEDITED REVIEW

Coronary Calcification, Coronary Disease Risk Factors, C-Reactive Protein, and Atherosclerotic Cardiovascular Disease Events

The St. Francis Heart Study

Yadon Arad, MD, FACC, Kenneth J. Goodman, MD, Marguerite Roth, RN, David Newstein, DrPh and Alan D. Guerci, MD, FACC*

Research Department, St. Francis Hospital, Roslyn, New York.

Manuscript received December 28, 2004; revised manuscript received February 17, 2005, accepted February 22, 2005.

* Reprint requests and correspondence: Dr. Alan D. Guerci, St. Francis Hospital, 100 Port Washington Boulevard, Roslyn, New York 11576. (Email: alan.guerci{at}chsli.org).

OBJECTIVES: The purpose of this study was to determine the prognostic accuracy of electron beam computed tomographic (CT) scanning of the coronary arteries and the relationship of coronary calcification to standard coronary disease risk factors and C-reactive protein (CRP) in the prediction of atherosclerotic cardiovascular disease (ASCVD) events in apparently healthy middle-age persons.

BACKGROUND: As a screening test for coronary artery disease (CAD), electron beam CT scanning remains controversial.

METHODS: In a prospective, population-based study, 4,903 asymptomatic persons age 50 to 70 years underwent electron beam CT scanning of the coronary arteries.

RESULTS: At 4.3 years, follow-up was available in 4,613 participants (94%), and 119 had sustained at least one ASCVD event. Subjects with ASCVD events had higher baseline coronary calcium scores (median [interquartile range], Agatston method) than those without events: 384 (127, 800) versus 10 (0, 86) (p < 0.0001). For coronary calcium score threshold ≥100 versus <100, relative risk (95% confidence interval) was 9.6 (6.7 to 13.9) for all ASCVD events, 11.1 (7.3 to 16.7) for all CAD events, and 9.2 (4.9 to 17.3) for non-fatal myocardial infarction and death. The coronary calcium score predicted CAD events independently of standard risk factors and CRP (p = 0.004), was superior to the Framingham risk index in the prediction of events (area under the receiver-operating characteristic curve of 0.79 ± 0.03 vs. 0.69 ± 0.03, p = 0.0006), and enhanced stratification of those falling into the Framingham categories of low, intermediate, and high risk (p < 0.0001).

CONCLUSIONS: The electron beam CT coronary calcium score predicts CAD events independent of standard risk factors, more accurately than standard risk factors and CRP, and refines Framingham risk stratification.

Abbreviations and Acronyms
  ASCVD = atherosclerotic cardiovascular disease
  CAD = coronary artery disease
  CI = confidence interval
  CRP = C-reactive protein
  CT = computed tomography/tomographic
  HDL = high-density lipoprotein
  LDL = low-density lipoprotein
  MI = myocardial infarction
  ROC = receiver-operating characteristic


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J J Bax, R S Beanlands, F J Klocke, J Knuuti, A A Lammertsma, M A Schaefers, H R Schelbert, G K Von Schulthess, L J Shaw, G Z Yang, et al.
Diagnostic and clinical perspectives of fusion imaging in cardiology: is the total greater than the sum of its parts?
Heart, January 1, 2007; 93(1): 16 - 22.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
R. J. Gibbons, P. A. Araoz, and E. E. Williamson
The Year in Cardiac Imaging
J. Am. Coll. Cardiol., December 5, 2006; 48(11): 2324 - 2339.
[Full Text] [PDF]

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 Arch Intern MedHome page
S. S. Gidding, C. A. McMahan, H. C. McGill, L. A. Colangelo, P. J. Schreiner, O. D. Williams, and K. Liu
Prediction of Coronary Artery Calcium in Young Adults Using the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Risk Score: The CARDIA Study
Arch Intern Med, November 27, 2006; 166(21): 2341 - 2347.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
M. J. Budoff, S. Achenbach, R. S. Blumenthal, J. J. Carr, J. G. Goldin, P. Greenland, A. D. Guerci, J. A.C. Lima, D. J. Rader, G. D. Rubin, et al.
Assessment of Coronary Artery Disease by Cardiac Computed Tomography: A Scientific Statement From the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology
Circulation, October 17, 2006; 114(16): 1761 - 1791.
[Full Text] [PDF]

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 Postgrad. Med. J.Home page
T. K Mittal, M. Barbir, and M. Rubens
Role of computed tomography in risk assessment for coronary heart disease.
Postgrad. Med. J., October 1, 2006; 82(972): 664 - 671.
[Abstract] [Full Text] [PDF]

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 HypertensionHome page
A. Simon, G. Chironi, and J. Levenson
Performance of Subclinical Arterial Disease Detection as a Screening Test for Coronary Heart Disease
Hypertension, September 1, 2006; 48(3): 392 - 396.
[Abstract] [Full Text] [PDF]

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 J. Lipid Res.Home page
J. R. Crouse III
Thematic review series: Patient-Oriented Research. Imaging atherosclerosis: state of the art
J. Lipid Res., August 1, 2006; 47(8): 1677 - 1699.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
A. Schmermund and R. Erbel
Letter by Schmermund and Erbel Regarding Article, "Coronary Artery Calcium: Should We Rely on This Surrogate Marker?"
Circulation, August 1, 2006; 114(5): e82 - e82.
[Full Text] [PDF]

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 CirculationHome page
R. F. Redberg
Response to Letter Regarding Article, "Coronary Artery Calcium: Should We Rely on This Surrogate Marker?"
Circulation, August 1, 2006; 114(5): e83 - e83.
[Full Text] [PDF]

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 J Am Coll CardiolHome page
J. A. Rumberger
Noncardiac Abnormalities in Diagnostic Cardiac Computed Tomography: Within Normal Limits or We Never Looked!
J. Am. Coll. Cardiol., July 18, 2006; 48(2): 407 - 408.
[Full Text] [PDF]

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 J Am Coll CardiolHome page
M. J. Budoff
Prevalence of Soft Plaque Detection With Computed Tomography
J. Am. Coll. Cardiol., July 18, 2006; 48(2): 319 - 321.
[Full Text] [PDF]

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 JNMHome page
D. S. Berman, R. Hachamovitch, L. J. Shaw, J. D. Friedman, S. W. Hayes, L. E.J. Thomson, D. S. Fieno, G. Germano, N. D. Wong, X. Kang, et al.
Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Noninvasive Risk Stratification and a Conceptual Framework for the Selection of Noninvasive Imaging Tests in Patients with Known or Suspected Coronary Artery Disease
J. Nucl. Med., July 1, 2006; 47(7): 1107 - 1118.
[Abstract] [Full Text] [PDF]

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 CJASNHome page
S. M. Moe and G. M. Chertow
The Case against Calcium-Based Phosphate Binders
Clin. J. Am. Soc. Nephrol., July 1, 2006; 1(4): 697 - 703.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
A. D. Guerci and D. Newstein
Reply
J. Am. Coll. Cardiol., June 6, 2006; 47(11): 2340 - 2340.
[Full Text] [PDF]

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 J Am Coll CardiolHome page
A. Boyar
Sensitivity and Specificity Versus Calcium Score in the St. Francis Heart Study
J. Am. Coll. Cardiol., June 6, 2006; 47(11): 2339 - 2340.
[Full Text] [PDF]

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 ANN INTERN MEDHome page
M. A. Whooley
Mind your heart.
Ann Intern Med, June 6, 2006; 144(11): 858 - 860.
[Full Text] [PDF]

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 Arch Intern MedHome page
P. G. O'Malley
Atherosclerosis imaging of asymptomatic individuals: is the sales cart before the evidence horse?
Arch Intern Med, May 22, 2006; 166(10): 1065 - 1068.
[Full Text] [PDF]

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 Arch Intern MedHome page
P. Raggi
Noninvasive imaging of atherosclerosis among asymptomatic individuals.
Arch Intern Med, May 22, 2006; 166(10): 1068 - 1071.
[Full Text] [PDF]

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 CirculationHome page
R. S. Vasan
Biomarkers of Cardiovascular Disease: Molecular Basis and Practical Considerations
Circulation, May 16, 2006; 113(19): 2335 - 2362.
[Full Text] [PDF]


 
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