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Electron-beam tomography coronary calcium scores are superior to framingham risk variables for predicting the measured proximal stenosis burden

      Abstract

      Previous studies of electron-beam tomography (EBT) have correlated coronary calcium scores with simplistic visual estimates of disease severity. In a clinical trial designed to evaluate 2 treatment strategies in coronary artery disease (CAD) patients with low levels of high-density lipoprotein cholesterol, we used quantitative coronary angiography to measure composite proximal stenosis burden from the baseline coronary angiogram and assessed the traditional Framingham risk variables in 146 patients. Stenosis burden is the sum, per patient, of percent stenosis for the worst lesion found in each of 9 standard proximal coronary segments. EBT estimates of coronary calcium (Agatston score, calcium volume score) were obtained for 115 of these patients. Stenosis burden was correlated with the calcium scores and risk variables. The best traditional correlates of stenosis burden were smoking status (r = 0.31, p = 0.001), prior myocardial infarction (r = 0.24, p = 0.005), body mass index (r = 0.23, p = 0.005), pack-years smoking (r = 0.20, p = 0.05), and age (r = 0.17, p = 0.04). With adjustment for age, all these correlations improved (eg, body mass index × age [r = 0.28, p = 0.001]). In addition, total cholesterol × age (r = 0.22, p = 0.008), fibrinogen × age (r = 0.19, p = 0.03), and systolic blood pressure × age (r = 0.18, p = 0.03) became significant correlates. Spearman correlations of the calcium scores with stenosis burden were considerably greater (Agatston: r = 0.62, p <0.0001; calcium volume: r = 0.63, p <0.0001). In multivariate regression analysis, calcium score, body mass index, and history of myocardial infarction were independent correlates of stenosis burden (R2 = 0.45). At a given point in time, the EBT coronary calcium scores are greatly superior to the Framingham risk factors in predicting the measured proximal stenosis burden. Agatston and calcium volume scores are comparably predictive of stenosis burden.
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      References

        • Mautner G.C
        • Mautner S.L
        • Froehlich J
        • Feuerstein I.M
        • Proschan M.A
        • Roberts W.C
        • Doppman J.L
        Coronary artery calcification.
        Radiology. 1994; 192 ([see comments]): 619-623
        • Rumberger J.A
        • Simons D.B
        • Fitzpatrick L.A
        • Sheedy P.F
        • Schwartz R.S
        Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area.
        Circulation. 1995; 92 ([see comments]): 2157-2162
        • Arad Y
        • Spadaro L.A
        • Goodman K
        • Lledo-Perez A
        • Sherman S
        • Lerner G
        • Guerci A.D
        Predictive value of electron beam computed tomography of the coronary arteries. 19-month follow-up of 1173 asymptomatic subjects.
        Circulation. 1996; 93 ([see comments]): 1951-1953
        • Agatston A.S
        • Janowitz W.R
        • Hildner F.J
        • Zusmer N.R
        • Viamonte Jr, M
        • Detrano R
        Quantification of coronary artery calcium using ultrafast computed tomography.
        J Am Coll Cardiol. 1990; 15: 827-832
        • Detrano R.C
        • Wong N.D
        • Doherty T.M
        • Shavelle R.M
        • Tang W
        • Ginzton L.E
        • Budoff M.J
        • Narahara K.A
        Coronary calcium does not accurately predict near-term future coronary events in high-risk adults.
        Circulation. 1999; 99 ([see comments] [published errata appear in Circulation 2000 Feb 15;101:697 and 2000 Mar 21;101:1355]): 2633-2638
        • Bielak L.F
        • Rumberger J.A
        • Sheedy II, P.F
        • Schwartz R.S
        • Peyser P.A
        Probabilistic model for prediction of angiographically defined obstructive coronary artery disease using electron beam computed tomography calcium score strata.
        Circulation. 2000; 102: 380-385
        • Sangiorgi G
        • Rumberger J.A
        • Severson A
        • Edwards W.D
        • Gregoire J
        • Fitzpatrick L.A
        • Schwartz R.S
        Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans.
        J Am Coll Cardiol. 1998; 31: 126-133
        • Budoff M.J
        • Georgiou D
        • Brody A
        • Agatston A.S
        • Kennedy J
        • Wolfkiel C
        • Stanford W
        • Shields P
        • Lewis R.J
        • Janowitz W.R
        • Rich S
        • Brundage B.H
        Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease.
        Circulation. 1996; 93: 898-904
        • Brown B.G
        • Zhao X.Q
        • Chait A
        • Fisher L.D
        • Dowdy A
        • Cheung M
        • Morse J.S
        • Serafini L
        • Huss-Frechette E
        • DeAngelis D
        • Frohlich J
        • Albers J.J
        Niacin plus simvastatin, but not antioxidant vitamins, protect against atherosclerosis and clinical events in CAD patients with low HDLC.
        Circulation. 2000; 102 ([abstract]): I-506
        • Brown B.G
        • Hillger L.A
        • Lewis C
        • Zhao X.Q
        • Sacco D
        • Bisson B
        • Fisher L
        A maximum confidence approach for measuring progression and regression of coronary artery disease in clinical trials.
        Circulation. 1993; 87: II-66-II-73
        • Callister T.Q
        • Cooil B
        • Raya S.P
        • Lippolis N.J
        • Russo D.J
        • Raggi P
        Coronary artery disease.
        Radiology. 1998; 208 ([see comments]): 807-814
        • Wilson P.W
        • D’Agostino R.B
        • Levy D
        • Belanger A.M
        • Silbershatz H
        • Kannel W.B
        Prediction of coronary heart disease using risk factor categories.
        Circulation. 1998; 97 ([see comments]): 1837-1847
        • Brown G
        • Albers J.J
        • Fisher L.D
        • Schaefer S.M
        • Lin J.T
        • Kaplan C
        • Zhao X.Q
        • Bisson B.D
        • Fitzpatrick V.F
        • Dodge H.T
        Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B.
        N Engl J Med. 1990; 323 ([see comments]): 1289-1298
        • Guerci A.D
        • Spadaro L.A
        • Goodman K.J
        • Lledo-Perez A
        • Newstein D
        • Lerner G
        • Arad Y
        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; 32: 673-679
        • Hasdai D
        • Bell M.R
        • Grill D.E
        • Berger P.B
        • Garratt K.N
        • Rihal C.S
        • Hammes L.N
        • Holmes Jr, D.R
        Outcome ≥10 years after successful percutaneous transluminal coronary angioplasty.
        Am J Cardiol. 1997; 79: 1005-1011