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Prognostic significance of coronary calcific deposits in asymptomatic high-risk subjects
R C Detrano1, N D Wong, T M Doherty
1Harbor-UCLA Medical Center, Torrance 90502-2064, USA.
Insights
Coronary calcification in asymptomatic adults predicts heart disease events, similar to traditional risk factors. Identifying calcified arteries improves risk assessment for coronary heart disease (CHD) events.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Coronary heart disease (CHD) remains a leading cause of mortality.
- Accurate risk stratification in asymptomatic individuals is crucial for preventive strategies.
- Traditional risk factors may not fully capture the risk in all populations.
Purpose of the Study:
- To evaluate the predictive capability of coronary calcifications for CHD events.
- To assess the value of coronary artery calcification in high-risk, asymptomatic adults.
- To compare the predictive power of coronary calcification with established risk factors.
Main Methods:
- Prospective cohort study of 1,461 high-risk, asymptomatic subjects.
- Follow-up duration of 55 months with 98% success rate.
- Cardiac fluoroscopy used to quantify coronary artery calcification; risk factors assessed.
Main Results:
- 58% of subjects had detectable coronary calcification.
- Calcification in multiple coronary arteries significantly increased risk (2.2 times) of coronary death or myocardial infarction.
- Number of calcified arteries, age, cholesterol, diabetes, and left ventricular hypertrophy were independent predictors.
Conclusions:
- Coronary calcification is a significant predictor of CHD death or myocardial infarction in high-risk asymptomatic adults.
- The predictive value of coronary calcification is comparable to standard CHD risk factors.
- Coronary artery calcification assessment can enhance risk stratification in this population.
Purpose:
To determine the predictive value of coronary calcifications for coronary heart disease events in high-risk, asymptomatic adults:
Patients And Methods:
A prospective cohort study of 1,461 high-risk, asymptomatic subjects were followed for 55 months with a 98% success rate. Coronary risk factor assessment and cardiac fluoroscopy with digital subtraction enhancement were performed to determine the number of calcified coronary arteries.
Results:
Fifty-eight percent of this cohort (852 subjects) had fluoroscopically detectable coronary calcification: 437 (30%) had calcium in one, 253 (17%) in two, and 162 (11%) in all three coronary vessels. There were 90 (6%) deaths, 35 (39%) attributable to coronary heart disease, and 43 (3%) nonfatal myocardial infarctions. Subjects with calcification in more than one major coronary artery were 2.2 times more likely to suffer coronary death or nonfatal infarction (P = 0.001) than were subjects with one or no calcified arteries. Multivariable logistic regression analysis showed that only the number of calcified arteries, age, total cholesterol, history of diabetes, and left ventricular hypertrophy by electrocardiogram were associated independently with the incidence of coronary death or infarction in these subjects.
Conclusions:
Coronary calcification predicts coronary heart disease death or infarction in high-risk asymptomatic adults as well as do standard risk factors.