Clinical and angiographic profile of patients with markedly elevated coronary calcium scores (≥1000) detected by electron beam computed tomography
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.
References (9)
- et al.
Comparison of electron beam computed tomography scanning and conventional risk factor assessment for the prediction of angiographic coronary artery disease
J Am Coll Cardiol
(1998) - et al.
High coronary artery calcium scores pose an extremely elevated risk for hard events
J Am Coll Cardiol
(2002) - et al.
Electron beam tomography comparison of culprit and non-culprit coronary arteries in patients with acute myocardial infarction
Am J Cardiol
(2000) - et al.
Ultrafast computed tomography in coronary screening
Circulation
(1994)
Cited by (6)
Coronary computed tomography angiography and calcium scoring in routine clinical practice for identification of patients who require revascularization
2016, Archives of Cardiovascular DiseasesCitation Excerpt :CCTA is an ideal non-invasive method for ruling out obstructive CAD, but the combination of CCTA and functional non-invasive imaging techniques might play an important role in clinical practice in selecting patients who require ICA and revascularization. Finally, referral for revascularization in patients with a high CACS should rely on the patient's symptoms and reversible ischemia demonstrated during a functional assessment [25,26]. Consequently, we support the conclusion that was reached in the articles discussed above that, although imaging quality has improved considerably, CCTA alone should not be used to identify patients who require revascularization.
Differentiation of severe coronary artery calcification in the Multi-Ethnic Study of Atherosclerosis
2011, AtherosclerosisCitation Excerpt :Although elevated CAC is known to be a risk factor for CHD events, little is known about the distinction between those with high (400–999) and very high CAC (≥1000). Studies among symptomatic patients receiving both CAC scanning and angiography note that patients with very high CAC (≥1000) are more likely to have coronary stenoses than those with lower CAC [7,8]. Wayhs et al. reported on a series of patients referred for rapid CT scanning with CAC ≥1000 in the late 1990s who had a very high risk for MI or death during follow-up (25% annualized event rate) [9].
Association between arterial pressure and coronary artery calcification
2007, Journal of Hypertension