Elsevier

Cardiovascular Radiation Medicine

Volume 5, Issue 3, July–September 2004, Pages 109-112
Cardiovascular Radiation Medicine

Clinical and angiographic profile of patients with markedly elevated coronary calcium scores (≥1000) detected by electron beam computed tomography

https://doi.org/10.1016/j.carrad.2004.07.001Get rights and content

Abstract

Objective

The objective of this study was to determine the clinical and angiographic profile of patients with extremely high coronary artery calcium scores (CACS; ≥1000) by electron beam computed tomography (EBCT).

Methods

All patients at Rush University Medical Center who had a calcium score ≥1000 and a coronary angiogram performed from 1997 to 2002 were identified using a prospectively collected database. The baseline demographics, symptom status, and degree of coronary stenosis by angiography and subsequent rate of coronary intervention were compared with that of patients with calcium scores <1000.

Results

The clinical and angiographic profile of patients with severe coronary calcification, detected by EBCT, revealed that patients with scores ≥1000 had a significantly higher prevalence of coronary stenosis ≥50% compared with patients with scores <1000 (97% vs. 57%, P<.001). The group with CACS ≥1000 was more likely to be male (90% vs. 75%, P=.027) and was older (64±8 vs. 59±10, P=.001) compared with the group with less severe calcification. Although there was a significantly higher rate of luminal stenosis detected by coronary angiography in the cohort with CACS ≥1000, there was no difference in subsequent percutaneous coronary intervention (PCI) and utilization of intracoronary stents between the two groups.

Conclusions

A markedly elevated coronary calcium score (≥1000) is correlated with increasing age and is associated with an increased likelihood of coronary stenosis ≥50%. However, the decision to perform coronary angiography in patients with severe coronary calcification should not be based solely on these findings, but should remain primarily dependent on the degree of ischemia detected by clinical and functional assessment.

Introduction

Although an elevated coronary artery calcium score (CACS) using electron beam computed tomography (EBCT) has been shown to be a significant predictor of future cardiac events, the clinical and angiographic profile of patients with extremely high scores (≥1000) is not clearly defined.

Section snippets

Patient population

Using a prospectively collected database, all patients at a single, large tertiary referral center (Rush University Medical Center) who had an EBCT from April 1997 to August 2002 and subsequent coronary angiogram performed within 30 days were identified. The baseline demographics, symptom status, and degree of coronary calcification by EBCT and luminal stenosis by coronary angiography of patients and subsequent rate of percutaneous coronary intervention (PCI) with CACS ≥1000 were compared with

Results

A total of 246 patients who had an EBCT and a subsequent coronary angiogram within 30 days was identified. Fifty-two participants (21.1%) had severe calcification (CACS ≥1000), and 194 patients (78.9%) had a CACS <1000. The mean score in the group with CACS ≥1000 was 2078±1252, and the mean score in the group with CACS <1000 was 315±268. The clinical and angiographic profile of patients in these two groups is outlined (Table 1). The angiographic correlates for varying degrees of coronary

Discussion

Coronary calcification has been strongly correlated with the presence of significant atherosclerosis by histopathologic analysis [2]. Elevated CACS using EBCT has been shown to be a significant predictor of future cardiac events [3], [4], [5]; however, the clinical and angiographic profile of patients with extremely high scores (≥1000) has not been fully evaluated. Previous studies have demonstrated a modest relationship between the extent of coronary calcification and the severity of luminal

Conclusions

A markedly elevated coronary calcium score ( ≥1000) is correlated with increasing age and is associated with an increased likelihood of coronary stenosis ≥50%. However, the decision to perform coronary angiography in patients with severe coronary calcification should not be based solely on these findings, but should remain primarily dependent on the degree of ischemia detected by clinical and functional assessment.

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