Prognostic value of extensive coronary calcium quantities in symptomatic males--a 5-year follow-up study.
OBJECTIVE
Coronary calcium scores (CSs) have been shown to predict future events in patients presenting for first-time evaluation of CAD. Long-term outcome data on symptomatic subjects with advanced CAD are limited. In this study, we evaluated the prognostic value of very high coronary CSs in symptomatic males undergoing angiography and analyzed the impact of event definitions on identification of risk predictor's.


RESULTS
Fifty consecutive symptomatic males with electron beam computed tomography (EBT)-based CSs >1000 were matched 1:2 by age with symptomatic males with scores between 400-1000 and 100-400. All 150 patients underwent coronary angiography. CAD risk factors were ascertained. Events were analyzed after 5 years for: (1) hard coronary events (coronary death and myocardial infarction); (2) overall hard events (adding stroke and non-coronary deaths); and (3) all events (including long-term revascularizations). During follow-up, 17 deaths, two infarctions and three strokes occurred in 21 patients; 38 patients underwent 43 revascularizations. Events occurred earlier and more frequently in patients with scores >1000. Left main disease was the only independent predictor of hard coronary events (hazard ratio, 4.5; 95% confidence interval, 1.1-17.8). Left main disease (4.3; 1.4-13.0) and CSs (1.7; 1.1-2.5) independently predicted overall hard events. Only CSs>90th percentile independently predicted all events (2.5; 1.3-4.8).


CONCLUSIONS
Symptomatic males with extensive CSs carry an even higher risk for future events than other symptomatic males with advanced CAD. In these patients, EBT-based calcified plaque burden and angiographic indices of disease severity may have a complementary role in predicting future cardiovascular events.
Möhlenkamp
Stefan
S
Clinic of Cardiology, University Clinic Essen, Hufelandstrasse 55, 45122 Essen, Germany. stefan.moehlenkamp@uni-essen.de
Lehmann
Nils
N
Schmermund
Axel
A
Pump
Heiko
H
Moebus
Susanne
S
Baumgart
Dietrich
D
Seibel
Rainer
R
Grönemeyer
Dietrich H W
DH
Jöckel
Karl-Heinz
KH
Erbel
Raimund
R
D002114:Calcinosis / Q000000981:diagnostic imaging / Q000378:metabolism*; D002118:Calcium / Q000378:metabolism*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000378:metabolism*; D003331:Coronary Vessels / Q000737:chemistry*; D016757:Death, Sudden, Cardiac; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009204:Myocardial Revascularization; D012307:Risk Factors; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed / Q000379:methods
D002118:Calcium