CLINICAL RESEARCH: CORONARY ARTERY DISEASE
Coronary Artery Calcium to Predict All-Cause Mortality in Elderly Men and Women
Paolo Raggi, MD*, ,*,
Maria C. Gongora, MD*,
Ambarish Gopal, MD ,
Tracy Q. Callister, MD ,
Matthew Budoff, MD and
Leslee J. Shaw, PhD*
* Division of Cardiology and Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
Division of Cardiology and Department of Medicine, Harbor UCLA, University of California, Torrance, California
Tennessee Heart and Vascular Institute, Nashville, Tennessee.
Manuscript received January 31, 2008;
revised manuscript received March 18, 2008,
accepted April 2, 2008.
* Reprint requests and correspondence: Dr. Paolo Raggi, 1365 Clifton Road NE, AT-504, Atlanta, Georgia 30322. (Email: praggi{at}emory.edu).
Objectives: We sought to study the prognostic utility of coronary artery calcium (CAC) in the elderly.
Background: The prognostic significance of CAC in the elderly is not well known.
Methods: All-cause mortality was assessed in 35,388 patients (3,570 were  70 years old at screening, and 50% were women) after a mean follow-up of 5.8 ± 3 years.
Results: In older patients, risk factors and CAC were more prevalent. Overall survival was 97.9% at the end of follow-up. Mortality increased with each age decile with a relative hazard of 1.09 (95% confidence interval: 1.08 to 1.10, p < 0.0001), and rates were greater for men than women (hazard ratio: 1.53; 95% confidence interval: 1.32 to 1.77, p < 0.0001). Increasing CAC scores were associated with decreasing survival across all age deciles (p < 0.0001). Survival for a <40-year and 80-year-old man with a CAC score 400 was 88% and 19% (95% and 44% for a woman, p < 0.0001), respectively. Among the 20,562 patients with no CAC, annual mortality rates ranged from 0.3% to 2.2% for patients age 40 to 49 years or 70 years (p < 0.0001). The use of CAC allowed us to reclassify more than 40% of the patients 70 years old more often by excluding risk (i.e., CAC <400) in those with >3 risk factors.
Conclusions: Despite their limited life expectancy, the use of CAC discriminates mortality risk in the elderly. Furthermore, the use of CAC allows physicians to reclassify risk in the elderly.
Key Words: coronary calcium • prognosis • elderly • gender • mortality
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Abbreviations and Acronyms
| | CAC = coronary artery calcium | | CI = confidence interval | | EBT = electron beam tomography | | FRS = Framingham risk score | | HR = hazard ratio |
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