Coronary calcium and standard risk factors in symptomatic patients referred for coronary angiography

doi:10.1016/S0002-8703(98)70288-1

American Heart Journal

Volume 135, Issue 4, April 1998, Pages 696-702

https://doi.org/10.1016/S0002-8703(98)70288-1 Get rights and content

Abstract

Objectives: The purpose of this study was to compare quantitative estimates of coronary calcification with traditional coronary risk factors to determine their independent predictive power for the diagnosis of obstructive angiographic coronary artery disease in symptomatic patients. Methods: Three hundred sixty-eight symptomatic patients underwent coronary angiography and electron beam computed tomography at four different centers between April 1989 and December 1993. A blinded cardiologist interpreted the electron beam computed tomograms. Coronary risk factors were obtained in all 368 patients. Both bivariate and multivariate analyses were used to investigate the relation between risk factors and angiographic disease. Results: One hundred fifty-eight patients (43%) had angiographically obstructive coronary artery disease (>50% luminal stenosis) and 297 (81%) had coronary calcification. At the bivariate level, only male sex and log-transformed coronary calcification were predictive of angiographic disease (p = 0.008, p = 0.001). By multivariate analysis, only male sex and coronary calcification were predictive (p = 0.001, p = 0.001). Sixty-four of the 71 patients without coronary calcification did not have disease, yielding a negative predictive value of 90%. Receiver operating characteristic curve analysis showed that the amount of coronary calcium was a significantly better discriminator of disease than were the other risk factors. Conclusions: Coronary calcification is a stronger predictor of angiographic coronary artery disease in symptomatic patients undergoing angiography than are standard risk factors. (Am Heart J 1998;135:696-702.)

Section snippets

Patient selection

This comparative multicenter study involved 368 symptomatic patients who underwent coronary angiography and EBCT at four different medical centers between April 1989 and December 1993, who fulfilled the following inclusion criteria:

1.
All computed tomographic studies were done within 3 months of the coronary angiograms.
2.
All computed tomographic (CT) studies used either the 26 cm, 30 cm, or 34 cm reconstruction field of view.
3.
All reconstructed image data could be retrieved by personnel at the

Description of study sample

Three hundred sixty-eight patients (211 men and 157 women) were enrolled from the four participating centers. The mean age was 54 ± 12 years. Two hundred ninety-seven (81%) had coronary calcification. Two hundred nineteen (60%) had coronary disease confirmed by angiography and 157 (43%) had obstructive angiographic disease (>50% stenosis).

Bivariate analysis

Interobserver differences in coronary calcium scores were 6.6% ± 11% for the subset of 31 studies, which were read by a second blinded observer. With the use

Discussion

The results of this investigation show that coronary calcification is a stronger independent predictor of angiographically obstructive CAD than are standard risk factors in symptomatic patients referred for angiography. Thus coronary calcification, when considered as a risk factor, is the most powerful of these for such patients.

ROC curves are depicted in Fig. 1, which shows the sensitivity on the vertical axis and the false-positive rate (1 – specificity) on the horizontal axis. The area under

Acknowledgements

We thank the physicians and technologists at the various centers who assisted in collecting the risk factor and image data and in reading the angiograms. In particular we thank Drs. James Fallavollita, Chris Wolfkiel, Paul Shields, William Stanford, and Steven Goldberg. We also thank Sharon Nickerson and David King of Imatron for their assistance in collecting the scan data. We appreciate the help of Dr. Angelo Secci for the assistance in the blinded interpretation of the scans and thank Eddie

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Coronary calcification is closely related to mural atheromatous plaque [10], which can be quantified by multi-detected row computed tomography (MDCT). The coronary calcium score (CCS) is proportionally associated with the severity of atherosclerotic disease [11], and is a strong predictor of future coronary artery event, independent of the traditional risk factors [12]. Taken together, these findings suggest that there may be a positive correlation between CCS and the presence of adenomatous polyps of colon, though few studies to date have examined this relationship.
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Among 1637 Korean adults, we examined the association between coronary calcium score (CCS) as a measurement of coronary calcification and the presence of adenomatous polyps of colon via multi-detected row computed tomography (MDCT) and colonoscopy, respectively. CCS values were categorized as follows: 0, 1–17, 18–105, or ≥ 106. The odds ratios (ORs) and 95% confidence intervals (CIs) for the presence of adenomatous polyps of colon were calculated across CCS groups.
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Citation Excerpt :
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^☆: From the ^aDepartment of Medicine, Harbor-UCLA Medical Center, and the ^bDepartment of Biostastics, University of California at Riverside.

^☆☆: Reprint requests: Robert Detrano, MD, PhD, Harbor-UCLA Medical Center, 1124 W. Carson St., Bldg. RB-2, Torrance, CA 90502. E-mail: [email protected]

^★: 4/1/87839

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Coronary calcium and standard risk factors in symptomatic patients referred for coronary angiography☆,☆☆,★

Abstract

Section snippets

Patient selection

Description of study sample

Bivariate analysis

Discussion

Acknowledgements

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

Coronary artery calcification: relationship to clinically significant coronary lesions and race, sex and topographic distribution

Circulation

Coronary artery calcification: a review

Am J Med Sci

Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease: a multicenter study

Circulation

System for quantitative analysis of coronary calcification via electron beam computed tomography

Proc SPIE Medical Imaging: Physiology and Function from Multidimensional Images

Enhanced coronary arterial calcification quantitation by fast CT

J Am Coll Cardiol