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Accelerated Progression of Coronary Calcification: Four-year Follow-up in Patients with Stable Coronary Artery Disease¹

¹ From the Grace Ballas Research Unit of the Cardiac Rehabilitation Institute (J.S., M.M.) and Department of Diagnostic Imaging (S.A., J.R., Y.I.), Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer 52621, Israel; Division of Epidemiology and Preventive Medicine, Tel-Aviv University, Tel-Hashomer, Israel (N.K.M.); and SOCAR Research Societe Anonyme, Nyon, Switzerland (B.A.K.). Received April 30, 2003; revision requested July 10; final revision received December 29; accepted January 30, 2004. Supported by a grant from Bayer, Leverkusen, Germany. Address correspondence to J.S. (e-mail: dshemesh@netvision.net.il).

PURPOSE: To prospectively assess the 4-year progression rate of coronary artery calcium (CAC) in patients with clinically stable coronary artery disease (CAD) with multi–detector row computed tomography (CT).

MATERIALS AND METHODS: The study group consisted of 382 consecutive patients. All underwent baseline dual-sector spiral CT, and CT was repeated at 2 and 4 years later. Progression of CAC was assessed with measurement of the increase in total calcium score (TCS) and with repeated-measures analysis and multivariate linear regression models. Logistic regression model was used to predict incidence of new lesions.

RESULTS: Eighty-seven percent (333 of 382) of the study group were men, with mean age of 65 years ± 11, and 13% (49 of 382) were women, with mean age of 68 years ± 11. The average TCS increased after 4 years by sixfold from baseline in the 1st quartile, and by four-, two- and 1.5-fold in the 2nd, 3rd, and 4th quartiles of baseline TCS (P < .01), respectively. Multiple linear regression analysis included age; sex; natural logarithm of baseline TCS; history of hypertension, diabetes mellitus, current smoking, hypercholesterolemia, and lipid-lowering therapy with cholesterol synthesis enzyme inhibitor (statin); and family history of premature CAD. Results demonstrated that natural logarithm of baseline TCS and history of current smoking were independent predictors of the 4th-year natural logarithm of TCS levels (R² = 0.85, P < .001). New lesions were diagnosed in 56 (15%) patients. History of statin therapy (odds ratio = 0.35; 95% confidence interval [CI]: 0.16, 0.77; P < .01), age with an increment of 5 years (odds ratio = 0.76; 95% CI: 0.64, 0.90; P = .01), and natural logarithm of baseline TCS (odds ratio = 0.73; 95% CI: 0.62, 0.86; P < .01) were independent predictors for new calcific lesions during 4 years.

CONCLUSION: Accelerated progression of CAC during 4 years was found in clinically stable patients with CAD.

© RSNA, 2004

Index terms: Computed tomography (CT), multi–detector row, 54.12119 • Coronary vessels, calcification, 54.81 • Coronary vessels, CT, 54.12119 • Coronary vessels, diseases, 54.76

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