(Circulation. 2000;101:850.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Identification of Patients at Increased Risk of First Unheralded Acute Myocardial Infarction by Electron-Beam Computed Tomography
Presented in part at the 48th Meeting of the American College of Cardiology, New Orleans, La, March 7–11, 1999. Tracy Q. Callister, Paolo Raggi, Nicholas J. Lippolis, Donald J. Russo. How should we use coronary artery calcium scores to predict events? J Am Coll Cardiol. 1999;33:414A. Abstract.
From EBT Research Foundation (T.Q.C., P.R., N.J.L., D.J.R.) and Vanderbilt University (B.C.), Nashville, Tenn; Baylor College of Medicine, Houston, Tex (Z.-X.H., J.J.M.); and Christ Hospital and Medical Center and Rush Medical College, Oak Lawn, Ill (A.Z.).
Correspondence to Paolo Raggi, MD, FACP, FACC, Director, EBT Research Foundation, 64 Valleybrook Dr, Hendersonville, TN 37075. E-mail praggi{at}attglobal.net
Background—There is a clear relationship between absolute calcium scores (CS) and severity of coronary artery disease. However, hard coronary events have been shown to occur across all ranges of CS.
Methods and Results—We conducted 2 analyses: in group A, 172 patients underwent electron-beam CT (EBCT) imaging within 60 days of suffering an unheralded myocardial infarction. In group B, 632 patients screened by EBCT were followed up for a mean of 32±7 months for the development of acute myocardial infarction or cardiac death. The mean patient age and prevalence of coronary calcification were similar in the 2 groups (53±8 versus 52±9 years and 96% each). In group B, the annualized event rate was 0.11% for subjects with CS of 0, 2.1% for CS 1 to 99, 4.1% for CS 100 to 400, and 4.8% for CS >400, and only 7% of the patients had CS >400. However, mild, moderate, and extensive absolute CSs were distributed similarly between patients with events in both groups (34%, 35%, and 27%, respectively, in group A and 44%, 30%, and 22% in group B). In contrast, the majority of events in both groups occurred in patients with CS >75th percentile (70% in each group).
Conclusions—Coronary calcium is present in most patients who suffer acute coronary events. Although the event rate is greater for patients with high absolute CSs, few patients have this degree of calcification on a screening EBCT. Conversely, the majority of events occur in individuals with high CS percentiles. Hence, CS percentiles constitute a more effective screening method to stratify individuals at risk.
Key Words: calcium • tomography • myocardial infarction • coronary disease
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W. Stanford, B. H. Thompson, T. L. Burns, S. D. Heery, and M. C. Burr Coronary Artery Calcium Quantification at Multi-Detector Row Helical CT versus Electron-Beam CT Radiology, February 1, 2004; 230(2): 397 - 402. [Abstract] [Full Text] [PDF]
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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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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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L. R. Van Hoe, K. G. De Meerleer, P. Ph. Leyman, and P. K. Vanhoenacker Coronary Artery Calcium Scoring Using ECG-Gated Multidetector CT: Effect of Individually Optimized Image-Reconstruction Windows on Image Quality and Measurement Reproducibility Am. J. Roentgenol., October 1, 2003; 181(4): 1093 - 1100. [Abstract] [Full Text] [PDF]
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L. J. Shaw, P. Raggi, E. Schisterman, D. S. Berman, and T. Q. Callister Prognostic Value of Cardiac Risk Factors and Coronary Artery Calcium Screening for All-Cause Mortality Radiology, September 1, 2003; 228(3): 826 - 833. [Abstract] [Full Text] [PDF]
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N. Takahashi and K. T. Bae Quantification of Coronary Artery Calcium with Multi-Detector row CT: Assessing Interscan Variability with Different Tube Currents—Pilot Study Radiology, July 1, 2003; 228(1): 101 - 106. [Abstract] [Full Text] [PDF]
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R. F. Redberg, R. A. Vogel, M. H. Criqui, D. M. Herrington, J. A. C. Lima, and M. J. Roman Task force #3--what is the spectrum of current and emerging techniques for the noninvasive measurement of atherosclerosis? J. Am. Coll. Cardiol., June 4, 2003; 41(11): 1886 - 1898. [Full Text] [PDF]
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K Pohle, D Ropers, R Maffert, P Geitner, W Moshage, M Regenfus, M Kusus, W G Daniel, and S Achenbach Coronary calcifications in young patients with first, unheralded myocardial infarction: a risk factor matched analysis by electron beam tomography Heart, June 1, 2003; 89(6): 625 - 628. [Abstract] [Full Text] [PDF]
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W. S. Weintraub Coronary Artery Calcium and Cardiac Events: Is Electron-Beam Tomography Ready for Prime Time? Circulation, May 27, 2003; 107(20): 2528 - 2530. [Full Text] [PDF]
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G. T. Kondos, J. A. Hoff, A. Sevrukov, M. L. Daviglus, D. B. Garside, S. S. Devries, E. V. Chomka, and K. Liu Electron-Beam Tomography Coronary Artery Calcium and Cardiac Events: A 37-Month Follow-Up of 5635 Initially Asymptomatic Low- to Intermediate-Risk Adults Circulation, May 27, 2003; 107(20): 2571 - 2576. [Abstract] [Full Text] [PDF]
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D V. Anand, D. Lipkin, and A. Lahiri Finding the age of the patient's heart BMJ, May 15, 2003; 326(7398): 1045 - 1046. [Full Text] [PDF]
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N. D. Wong, M. G. Sciammarella, D. Polk, A. Gallagher, L. Miranda-Peats, B. Whitcomb, R. Hachamovitch, J. D. Friedman, S. Hayes, and D. S. Berman The metabolic syndrome, diabetes, and subclinicalatherosclerosis assessed by coronary calcium J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1547 - 1553. [Abstract] [Full Text] [PDF]
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S. Mohlenkamp, N. Lehmann, A. Schmermund, H. Pump, S. Moebus, D. Baumgart, R. Seibel, D. H.W Gronemeyer, K.-H. Jockel, and R. Erbel Prognostic value of extensive coronary calcium quantities in symptomatic males--a 5-year follow-up study Eur. Heart J., May 1, 2003; 24(9): 845 - 854. [Abstract] [Full Text] [PDF]
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J. A. Hoff, L. Quinn, A. Sevrukov, R. B. Lipton, M. Daviglus, D. B. Garside, N. K. Ajmere, S. Gandhi, and G. T. Kondos The prevalence of coronary arterycalcium among diabetic individuals without known coronary artery disease J. Am. Coll. Cardiol., March 19, 2003; 41(6): 1008 - 1012. [Abstract] [Full Text] [PDF]
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W. Qu, T. T. Le, S. P. Azen, M. Xiang, N. D. Wong, T. M. Doherty, and R. C. Detrano Value of Coronary Artery Calcium Scanning by Computed Tomography for Predicting Coronary Heart Disease in Diabetic Subjects Diabetes Care, March 1, 2003; 26(3): 905 - 910. [Abstract] [Full Text] [PDF]
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R. S. Blumenthal, D. M. Becker, L. R. Yanek, T. R. Aversano, T. F. Moy, B. G. Kral, and L. C. Becker Detecting Occult Coronary Disease in a High-Risk Asymptomatic Population Circulation, February 11, 2003; 107(5): 702 - 707. [Abstract] [Full Text] [PDF]
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R. Detrano Counterpoint: Do People With Diabetes Benefit From Coronary Calcium Scans? Diabetes Care, February 1, 2003; 26(2): 543 - 544. [Full Text] [PDF]
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T. C. Lee, P. G. O'Malley, I. Feuerstein, and A. J. Taylor The prevalence and severity of coronaryartery calcification on coronary arterycomputed tomography in black and white subjects J. Am. Coll. Cardiol., January 1, 2003; 41(1): 39 - 44. [Abstract] [Full Text] [PDF]
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P. Hunold, F. M. Vogt, A. Schmermund, J. F. Debatin, G. Kerkhoff, T. Budde, R. Erbel, K. Ewen, and J. Barkhausen Radiation Exposure during Cardiac CT: Effective Doses at Multi-Detector Row CT and Electron-Beam CT Radiology, January 1, 2003; 226(1): 145 - 152. [Abstract] [Full Text] [PDF]
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