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(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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