Prognostic Significance of Coronary Calcific Deposits in Asymptomatic High-Risk Subjects

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Abstract

PURPOSE: To determine the predictive value of coronary calcifications for coronary heart disease events in high-risk, asymptomatic adults.

PATIENTS AND METHODS: A prospective cohort study of 1,461 high-risk, asymptomatic subjects were followed for 55 months with a 98% success rate. Coronary risk factor assessment and cardiac fluoroscopy with digital subtraction enhancement were performed to determine the number of calcified coronary arteries.

RESULTS: Fifty-eight percent of this cohort (852 subjects) had fluoroscopically detectable coronary calcification: 437 (30%) had calcium in one, 253 (17%) in two, and 162 (11%) in all three coronary vessels. There were 90 (6%) deaths, 35 (39%) attributable to coronary heart disease, and 43 (3%) nonfatal myocardial infarctions. Subjects with calcification in more than one major coronary artery were 2.2 times more likely to suffer coronary death or nonfatal infarction (P = 0.001) than were subjects with one or no calcified arteries. Multivariable logistic regression analysis showed that only the number of calcified arteries, age, total cholesterol, history of diabetes, and left ventricular hypertrophy by electrocardiogram were associated independently with the incidence of coronary death or infarction in these subjects.

CONCLUSIONS: Coronary calcification predicts coronary heart disease death or infarction in high-risk asymptomatic adults as well as do standard risk factors.

Section snippets

Recruitment of Subjects

The South Bay Heart Watch in Torrance, California, is a government-funded, prospective cohort study designed to test the value of radiographically detectable coronary calcification in predicting coronary heart disease outcome in high-risk asymptomatic adults. After a preliminary newspaper advertising campaign, we mailed 100,000 letters of invitation to households whose head was at least 45 years of age. These letters invited subjects with at least two coronary risk factors to participate in a

Patient Characteristics and Completeness of Follow-Up

The age, gender, and risk factor profile of the South Bay Heart Watch cohort are described in Table 1. All subjects were above 75th percentile of coronary heart disease risk.9, 14

All but one patient (99.9%) were successfully contacted during the first follow-up attempt. Follow-up rate remained over 98 percent for all four follow-up attempts.

Fluoroscopic Results

Fifty-eight percent of this cohort (852 subjects) had fluoroscopically detectable coronary calcium: 437 (30%) of the subjects had detectable calcium in only

Discussion

Pathologically confirmed coronary calcification always indicates the presence of coronary atherosclerosis.15, 16 The ubiquity of atherosclerosis in the Western world, therefore, is consistent with the high prevalence of radiographic coronary calcification seen in this and other studies.17, 18, 19 Despite this high prevalence, the observed 5-year incidence of coronary heart disease death and infarction in our cohort is only 5.3%. Therefore, when coronary atherosclerosis is detected by sensitive

Acknowledgements

Particular gratitude must be extended to Drs. Bruce Brundage, Kenneth Narahara, Demetrios Georgiou, and William French for their assistance as part of the ECG reading and adjudication committees. The nursing support of Oleh Brezden and Gail Puentes is deeply appreciated. Dr. Weiyi-Tang contributed greatly as Associate Director of the South Bay Heart Watch. Eddie F. Rodrigues and Ramon M. Valencia provided technical and editorial assistance.

This work was supported by Grant 7R01-HL-43277-02 from

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