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(Circulation. 1998;97:2095-2096.)
© 1998 American Heart Association, Inc.

Correspondence

Electron Beam CT and Coronary Calcium Score

John A. Rumberger, PhD, MD

Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn

To the Editors:

I read with enthusiasm the recent article by Secci et al.¹ This prospective study using electron beam CT (EBCT) and coronary calcium score was done in 326 mostly elderly (mean age, 66±8 years) men (82%). Hypertension (50%) and family history of coronary disease (44%) were common, but lipids were average (LDL 144±37 mg/dL, HDL 54±14 mg/dL). The 10-year Framingham risk was 19±9%. Each was followed up for 32 months after EBCT or until documentation of a hard (death, infarction) or a soft (need for revascularization) event. Dividing results into quartiles of EBCT calcium score, Secci et al found a clear trend for more total events in those with scores above the median. When hard and soft events were separated, there were still significantly more soft events when the score was above the median. However, despite a greater total number of events for subjects with calcium scores in the highest quartile, especially compared with those with scores in the lowest quartile, there was no significant trend for hard events alone.

My comments relate to four important issues not raised in the discussion. First, the amount of calcified plaque correlates, albeit as an underestimation, with the total atherosclerotic plaque burden (lipid-rich, fibrotic, and calcified fibrotic plaques) as shown by histological^{2 3} and ultrasonic^{4 5} studies. The discussion by Secci et al of calcified plaque and acute coronary syndromes totally misses the point regarding total plaque burden and vulnerable plaques, calcification, and inflammation.⁶ Second, the data⁷ given in their reference 16 states . . . [Full Text of this Article]

Robert Detrano, MD, PhD; ; Terence Doherty, BA

Harbor-UCLA Medical Center, Torrance, Calif

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