title: Coronary artery calcium and exercise electrocardiogram as predictors of coronary events in asymptomatic adults.
abstract: Early identification of patients at risk for coronary heart disease is crucial to formulate effective preventive strategies. The elevated risk of coronary artery calcium (CAC) for coronary heart disease is well established. Our aim was to estimate the relative risk of abnormal exercise electrocardiography (Ex ECG) in the presence of CAC. During the year 2001, 566 asymptomatic subjects performed a treadmill exercise test and consented to perform an unenhanced computed tomography to assess CAC. Patients were followed until December 2012. The relative risk for coronary events (acute myocardial infarction, hospitalization for unstable angina or coronary catheterization that resulted in angioplasty or coronary artery bypass surgery), of abnormal Ex ECG and presence of CAC were analyzed. An abnormal Ex ECG was found in 71 subjects (12.5%), and CAC was found in 286 subjects (50.5%). During a mean follow-up of 6.5 ± 3.3 years, 35 subjects experienced a first coronary event. In those without CAC, the rate of coronary events was low (4 of 280; 1.4%) regardless of the Ex ECG results. Subjects with both CAC and abnormal Ex ECG had the highest rate of coronary events (13 of 39; 33%). The adjusted hazard ratio for coronary events, in subjects with CAC, was 5.16 (95% confidence interval 2.52 to 10.60) in those with abnormal Ex ECG compared with those with normal Ex ECG. In conclusion, in subjects with CAC, further risk stratification can be achieved by an Ex ECG, whereas in those without CAC, an Ex ECG has less additional value in predicting coronary events.
authors.affiliation: Rheumatology Unit, The Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.
authors.forename: Chagai
authors.initials: C
authors.lastname: Grossman
authors.affiliation: Grace Ballas Research Unit, Cardiac Rehabilitation Institute, The Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.
authors.forename: Shay
authors.initials: S
authors.lastname: Ehrlich
authors.affiliation: Grace Ballas Research Unit, Cardiac Rehabilitation Institute, The Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.
authors.forename: Joseph
authors.initials: J
authors.lastname: Shemesh
authors.affiliation: Department of Epidemiology and Preventive Medicine, The Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel.
authors.forename: Nira
authors.initials: N
authors.lastname: Koren-Morag
authors.affiliation: Department of Internal Medicine D and the Hypertension Unit, The Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, Israel. Electronic address: grosse@post.tau.ac.il.
authors.forename: Ehud
authors.initials: E
authors.lastname: Grossman
mesh_terms: D015992:Body Mass Index; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000628:therapy; D018450:Disease Progression; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D061205:Vascular Calcification / Q000175:diagnosis* / Q000628:therapy