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J Am Coll Cardiol, 2008; 52:17-23, doi:10.1016/j.jacc.2008.04.004 © 2008 by the American College of Cardiology Foundation |
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* 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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Related Article
J. Am. Coll. Cardiol. 2008 52: A32.
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