| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Cardiac Imaging |
1 From the American Cardiovascular Research Institute, Atlanta, Ga (L.J.S.); Division of Cardiology, Tulane University School of Medicine, 1430 Tulane Ave, SL48, New Orleans, LA 70112 (P.R.); Cedars-Sinai Medical Center, Los Angeles, Calif (E.S., D.S.B.); and EBT Research Foundation, Nashville, Tenn (T.Q.C.). Received August 14, 2002; revision requested October 15; final revision received March 11, 2003; accepted March 20. Address correspondence to P.R. (e-mail: praggi@tulane.edu).
PURPOSE: To develop risk-adjusted multivariable models that included risk factors and coronary calcium scores determined with electron-beam computed tomography (CT) in asymptomatic patients for the prediction of all-cause mortality.
MATERIALS AND METHODS: We followed up a cohort of 10,377 asymptomatic individuals undergoing cardiac risk factor evaluation and coronary calcium screening with electron-beam CT. Multivariable Cox proportional hazards models were developed to predict all-cause mortality. Risk-adjusted models incorporated traditional risk factors for coronary disease and coronary calcium scores.
RESULTS: Cardiac risk factors such as family history of coronary disease (69%), hypercholesterolemia (62%), hypertension (44%), smoking (40%), and diabetes (9%) were prevalent. The frequency of coronary calcium scores was 57%, 20%, 14%, 6%, and 3% for scores of 10 or less, 11–100, 101–400, 401–1,000, and greater than 1,000, respectively. During a mean follow-up of 5.0 years ± 0.0086 (standard error of the mean), the death rate was 2.4%. In a risk-adjusted model (model 
2 = 388.2, P < .001), coronary calcium was an independent predictor of mortality (P < .001). Risk-adjusted relative risk values for coronary calcium were 1.64, 1.74, 2.54, and 4.03 for scores of 11–100, 101–400, 401–1,000, and greater than 1,000, respectively (P < .001 for all values), as compared with that for a score of 10 or less. Five-year risk-adjusted survival was 99.0% for a calcium score of 10 or less and 95.0% for a score of greater than 1,000 (P < .001). With a receiver operating characteristic curve, the concordance index increased from 0.72 for cardiac risk factors alone to 0.78 (P < .001) when the calcium score was added to a multivariable model for prediction of death.
CONCLUSION: This large observational data series shows that coronary calcium provides independent incremental information in addition to traditional risk factors in the prediction of all-cause mortality.
© RSNA, 2003
Index terms: Computed tomography (CT), electron beam, 54.1211 • Coronary vessels, calcification, 54.812
This article has been cited by other articles:
|
|
 |
|
  K. C. Hoang, H. Ghandehari, V. A. Lopez, M. G. Barboza, and N. D. Wong Global Coronary Heart Disease Risk Assessment of Individuals With the Metabolic Syndrome in the U.S. Diabetes Care, July 1, 2008; 31(7): 1405 - 1409. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E J HALL and D J BRENNER Cancer risks from diagnostic radiology Br. J. Radiol., May 1, 2008; 81(965): 362 - 378. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Raggi and M. Kleerekoper Contribution of Bone and Mineral Abnormalities to Cardiovascular Disease in Patients with Chronic Kidney Disease Clin. J. Am. Soc. Nephrol., May 1, 2008; 3(3): 836 - 843. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. P. Schenker, S. Dorbala, E. C. T. Hong, F. J. Rybicki, R. Hachamovitch, R. Y. Kwong, and M. F. Di Carli Interrelation of Coronary Calcification, Myocardial Ischemia, and Outcomes in Patients With Intermediate Likelihood of Coronary Artery Disease: A Combined Positron Emission Tomography/Computed Tomography Study Circulation, April 1, 2008; 117(13): 1693 - 1700. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Hemingway, C. Langenberg, J. Damant, C. Frost, K. Pyorala, and E. Barrett-Connor Prevalence of Angina in Women Versus Men: A Systematic Review and Meta-Analysis of International Variations Across 31 Countries Circulation, March 25, 2008; 117(12): 1526 - 1536. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Gottlieb and J. A.C. Lima Screening High-Risk Patients With Computed Tomography Angiography Circulation, March 11, 2008; 117(10): 1318 - 1332. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Winzenberg and G. Jones Recommended Calcium Intakes in Children: Have We Set the Bar Too High? IBMS BoneKEy, February 1, 2008; 5(2): 59 - 68. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Rutten, I. Isgum, and M. Prokop Coronary Calcification: Effect of Small Variation of Scan Starting Position on Agatston, Volume, and Mass Scores Radiology, December 1, 2007; 246(1): 90 - 98. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Leontiev and T. J. Dubinsky CT-Based Calcium Scoring to Screen for Coronary Artery Disease: Why Aren't We There Yet? Am. J. Roentgenol., November 1, 2007; 189(5): 1061 - 1063. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Burrill, Z. Dabbagh, F. Gollub, and M. Hamady Multidetector computed tomographic angiography of the cardiovascular system Postgrad. Med. J., November 1, 2007; 83(985): 698 - 704. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. T. Wilson, P. Gopalakrishnan, and T. Tak Noninvasive Cardiac Imaging with Computed Tomography Clin. Med. Res., October 1, 2007; 5(3): 165 - 171. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Bax, L. H. Young, R. L. Frye, R. O. Bonow, H. O. Steinberg, and E. J. Barrett Screening for Coronary Artery Disease in Patients With Diabetes Diabetes Care, October 1, 2007; 30(10): 2729 - 2736. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Nasir, L. J. Shaw, S. T. Liu, S. R. Weinstein, T. R. Mosler, P. R. Flores, F. R. Flores, P. Raggi, D. S. Berman, R. S. Blumenthal, et al. Ethnic Differences in the Prognostic Value of Coronary Artery Calcification for All-Cause Mortality J. Am. Coll. Cardiol., September 4, 2007; 50(10): 953 - 960. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Rumberger The Ethnic Rosetta Stone: Translating Risk Factors, Plaque Scores, and Mortality J. Am. Coll. Cardiol., September 4, 2007; 50(10): 961 - 963. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Schepis, O. Gaemperli, P. Koepfli, M. Namdar, I. Valenta, H. Scheffel, S. Leschka, L. Husmann, F. R. Eberli, T. F. Luscher, et al. Added Value of Coronary Artery Calcium Score as an Adjunct to Gated SPECT for the Evaluation of Coronary Artery Disease in an Intermediate-Risk Population J. Nucl. Med., September 1, 2007; 48(9): 1424 - 1430. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Nasir, M. J. Budoff, N. D. Wong, M. Scheuner, D. Herrington, D. K. Arnett, M. Szklo, P. Greenland, and R. S. Blumenthal Family History of Premature Coronary Heart Disease and Coronary Artery Calcification: Multi-Ethnic Study of Atherosclerosis (MESA) Circulation, August 7, 2007; 116(6): 619 - 626. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. K. Mehta, J. E. Rame, A. Khera, S. A. Murphy, R. M. Canham, R. M. Peshock, J. A. de Lemos, and M. H. Drazner Left Ventricular Hypertrophy, Subclinical Atherosclerosis, and Inflammation Hypertension, June 1, 2007; 49(6): 1385 - 1391. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Schuijf, G. Pundziute, and J. J. Bax Reply J. Am. Coll. Cardiol., May 22, 2007; 49(20): 2071 - 2071. [Full Text] [PDF]
|
|
|
|
|
|
A. D. Guerci The Prognostic Accuracy of Coronary Calcification J. Am. Coll. Cardiol., May 8, 2007; 49(18): 1871 - 1873. [Full Text] [PDF]
|
|
|
|
|
|
J. J. Bax, S. E. Inzucchi, R. O. Bonow, J. D. Schuijf, M. R. Freeman, E. J. Barrett, and on behalf of the Global Dialogue Group for the Eva Cardiac Imaging for Risk Stratification in Diabetes Diabetes Care, May 1, 2007; 30(5): 1295 - 1304. [Full Text] [PDF]
|
|
|
|
|
|
S. Sabour, A. Franx, A. Rutten, D. E. Grobbee, M. Prokop, M.-L. Bartelink, Y. T. van der Schouw, and M. L. Bots High Blood Pressure in Pregnancy and Coronary Calcification Hypertension, April 1, 2007; 49(4): 813 - 817. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Muntner, E. Ferramosca, A. Bellasi, G. A. Block, and P. Raggi Development of a cardiovascular calcification index using simple imaging tools in haemodialysis patients Nephrol. Dial. Transplant., February 1, 2007; 22(2): 508 - 514. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. M. Henneman, J. D. Schuijf, E. E. van der Wall, and J. J. Bax Non-invasive anatomical and functional imaging for the detection of coronary artery disease Br. Med. Bull., January 5, 2007; (2007) ldl014v2. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Pundziute, J. D. Schuijf, J. W. Jukema, E. Boersma, A. de Roos, E. E. van der Wall, and J. J. Bax Prognostic Value of Multislice Computed Tomography Coronary Angiography in Patients With Known or Suspected Coronary Artery Disease J. Am. Coll. Cardiol., January 2, 2007; 49(1): 62 - 70. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Waxman, F. Ishibashi, and J. E. Muller Detection and Treatment of Vulnerable Plaques and Vulnerable Patients: Novel Approaches to Prevention of Coronary Events Circulation, November 28, 2006; 114(22): 2390 - 2411. [Full Text] [PDF]
|
|
|
|
|
|
G. Ramakrishna, J. F. Breen, S. L. Mulvagh, R. B. McCully, and P. A. Pellikka Relationship Between Coronary Artery Calcification Detected by Electron-Beam Computed Tomography and Abnormal Stress Echocardiography: Association and Prognostic Implications J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2125 - 2131. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Budoff, S. Achenbach, R. S. Blumenthal, J. J. Carr, J. G. Goldin, P. Greenland, A. D. Guerci, J. A.C. Lima, D. J. Rader, G. D. Rubin, et al. Assessment of Coronary Artery Disease by Cardiac Computed Tomography: A Scientific Statement From the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology Circulation, October 17, 2006; 114(16): 1761 - 1791. [Full Text] [PDF]
|
|
|
|
 |
|
 T. T. de Weert, M. Ouhlous, E. Meijering, P. E. Zondervan, J. M. Hendriks, M. R.H.M. van Sambeek, D. W.J. Dippel, and A. van der Lugt In Vivo Characterization and Quantification of Atherosclerotic Carotid Plaque Components With Multidetector Computed Tomography and Histopathological Correlation Arterioscler. Thromb. Vasc. Biol., October 1, 2006; 26(10): 2366 - 2372. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. K Mittal, M. Barbir, and M. Rubens Role of computed tomography in risk assessment for coronary heart disease. Postgrad. Med. J., October 1, 2006; 82(972): 664 - 671. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. M. Jones, T. Athanasiou, N. Dunne, J. Kirby, S. Attaran, A. Chow, S. Purkayastha, and A. Darzi Multi-slice computed tomography in coronary artery disease. Eur. J. Cardiothorac. Surg., September 1, 2006; 30(3): 443 - 450. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C P Chung, A Oeser, I Avalos, P Raggi, and C M Stein Cardiovascular risk scores and the presence of subclinical coronary artery atherosclerosis in women with systemic lupus erythematosus Lupus, September 1, 2006; 15(9): 562 - 569. [Abstract] [PDF]
|
|
|
|
|
|
J. J. Bax, R. O. Bonow, D. Tschope, S. E. Inzucchi, E. Barrett, and on behalf of the Global Dialogue Group for the Eva The Potential of Myocardial Perfusion Scintigraphy for Risk Stratification of Asymptomatic Patients With Type 2 Diabetes J. Am. Coll. Cardiol., August 15, 2006; 48(4): 754 - 760. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. S. Berman, R. Hachamovitch, L. J. Shaw, J. D. Friedman, S. W. Hayes, L. E.J. Thomson, D. S. Fieno, G. Germano, N. D. Wong, X. Kang, et al. Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Noninvasive Risk Stratification and a Conceptual Framework for the Selection of Noninvasive Imaging Tests in Patients with Known or Suspected Coronary Artery Disease J. Nucl. Med., July 1, 2006; 47(7): 1107 - 1118. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Moe and G. M. Chertow The Case against Calcium-Based Phosphate Binders Clin. J. Am. Soc. Nephrol., July 1, 2006; 1(4): 697 - 703. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. D. Raptopoulos, P. B. Boiselle, N. Michailidis, J. Handwerker, A. Sabir, J. A. Edlow, I. Pedrosa, and J. B. Kruskal MDCT Angiography of Acute Chest Pain: Evaluation of ECG-Gated and Nongated Techniques Am. J. Roentgenol., June 1, 2006; 186(6_Supplement_2): S346 - S356. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Raggi Noninvasive imaging of atherosclerosis among asymptomatic individuals. Arch Intern Med, May 22, 2006; 166(10): 1068 - 1071. [Full Text] [PDF]
|
|
|
|
|
|
D. V. Anand, A. Lahiri, E. Lim, D. Hopkins, and R. Corder The Relationship Between Plasma Osteoprotegerin Levels and Coronary Artery Calcification in Uncomplicated Type 2 Diabetic Subjects J. Am. Coll. Cardiol., May 2, 2006; 47(9): 1850 - 1857. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. L. Yan, K. Liu, M. L. Daviglus, L. A. Colangelo, C. I. Kiefe, S. Sidney, K. A. Matthews, and P. Greenland Education, 15-year risk factor progression, and coronary artery calcium in young adulthood and early middle age: the Coronary Artery Risk Development in Young Adults study. JAMA, April 19, 2006; 295(15): 1793 - 1800. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. V. Anand, E. Lim, A. Lahiri, and J. J. Bax The role of non-invasive imaging in the risk stratification of asymptomatic diabetic subjects Eur. Heart J., April 2, 2006; 27(8): 905 - 912. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. J. Shaw, P. Raggi, T. Q. Callister, and D. S. Berman Prognostic value of coronary artery calcium screening in asymptomatic smokers and non-smokers Eur. Heart J., April 2, 2006; 27(8): 968 - 975. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Bax and E. E. van der Wall Risk assessment with coronary artery calcium scoring: effects of smoking at young age Eur. Heart J., April 2, 2006; 27(8): 899 - 900. [Full Text] [PDF]
|
|
|
|
|
|
D. V. Anand, E. Lim, D. Hopkins, R. Corder, L. J. Shaw, P. Sharp, D. Lipkin, and A. Lahiri Risk stratification in uncomplicated type 2 diabetes: prospective evaluation of the combined use of coronary artery calcium imaging and selective myocardial perfusion scintigraphy Eur. Heart J., March 2, 2006; 27(6): 713 - 721. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Budoff Aged Garlic Extract Retards Progression of Coronary Artery Calcification, J. Nutr., March 1, 2006; 136(3): 741S - 744S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Escolar, G. Weigold, A. Fuisz, and N. J. Weissman New imaging techniques for diagnosing coronary artery disease. Can. Med. Assoc. J., February 14, 2006; 174(4): 487 - 495. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. R. Nandalur, E. Baskurt, K. D. Hagspiel, M. Finch, C. D. Phillips, S. R. Bollampally, and C. M. Kramer Carotid Artery Calcification on CT May Independently Predict Stroke Risk Am. J. Roentgenol., February 1, 2006; 186(2): 547 - 552. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Clouse, J. Chen, H. M. Krumholz, M. E. Clouse, J. Chen, and H. M. Krumholz Noninvasive Screening for Coronary Artery Disease With Computed Tomography Is Useful Circulation, January 3, 2006; 113(1): 125 - 146. [Full Text] [PDF]
|
|
|
|
|
|
D. Mozaffarian Electron-Beam Computed Tomography for Coronary Calcium: A Useful Test to Screen for Coronary Heart Disease? JAMA, December 14, 2005; 294(22): 2897 - 2901. [Full Text] [PDF]
|
|
|
|
|
|
K. Nasir, E. D. Michos, R. S. Blumenthal, and P. Raggi Detection of High-Risk Young Adults and Women by Coronary Calcium and National Cholesterol Education Program Panel III Guidelines J. Am. Coll. Cardiol., November 15, 2005; 46(10): 1931 - 1936. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Raggi, A. Taylor, Z. Fayad, D. O'Leary, S. Nissen, D. Rader, and L. J. Shaw Atherosclerotic Plaque Imaging: Contemporary Role in Preventive Cardiology Arch Intern Med, November 14, 2005; 165(20): 2345 - 2353. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Schwaiger, S. Ziegler, and S. G. Nekolla PET/CT: Challenge for Nuclear Cardiology J. Nucl. Med., October 1, 2005; 46(10): 1664 - 1678. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Taylor, J. Bindeman, I. Feuerstein, F. Cao, M. Brazaitis, and P. G. O'Malley Coronary Calcium Independently Predicts Incident Premature Coronary Heart Disease Over Measured Cardiovascular Risk Factors: Mean Three-Year Outcomes in the Prospective Army Coronary Calcium (PACC) Project J. Am. Coll. Cardiol., September 6, 2005; 46(5): 807 - 814. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Raggi, M. Davidson, T. Q. Callister, F. K. Welty, G. A. Bachmann, H. Hecht, and J. A. Rumberger Aggressive Versus Moderate Lipid-Lowering Therapy in Hypercholesterolemic Postmenopausal Women: Beyond Endorsed Lipid Lowering With EBT Scanning (BELLES) Circulation, July 26, 2005; 112(4): 563 - 571. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Budoff, M. C. Cohen, M. J. Garcia, J. McB. Hodgson, W. G. Hundley, J. A.C. Lima, W. J. Manning, G. M. Pohost, P. M. Raggi, G. P. Rodgers, et al. ACCF/AHA Clinical Competence Statement on Cardiac Imaging With Computed Tomography and Magnetic Resonance: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training J. Am. Coll. Cardiol., July 19, 2005; 46(2): 383 - 402. [Full Text] [PDF]
|
|
|
|
|
|
P. Raggi, B. Cooil, C. Ratti, T. Q. Callister, and M. Budoff Progression of Coronary Artery Calcium and Occurrence of Myocardial Infarction in Patients With and Without Diabetes Mellitus Hypertension, July 1, 2005; 46(1): 238 - 243. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Nadra, J. C. Mason, P. Philippidis, O. Florey, C. D.W. Smythe, G. M. McCarthy, R. C. Landis, and D. O. Haskard Proinflammatory Activation of Macrophages by Basic Calcium Phosphate Crystals via Protein Kinase C and MAP Kinase Pathways: A Vicious Cycle of Inflammation and Arterial Calcification? Circ. Res., June 24, 2005; 96(12): 1248 - 1256. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. S. Celermajer Primary and a Half Prevention: Can We Identify Asymptomatic Subjects With High Vascular Risk? J. Am. Coll. Cardiol., June 21, 2005; 45(12): 1994 - 1996. [Full Text] [PDF]
|
|
|
|
|
|
N. D. Wong, A. Rozanski, H. Gransar, R. Miranda-Peats, X. Kang, S. Hayes, L. Shaw, J. Friedman, D. Polk, and D. S. Berman Metabolic Syndrome and Diabetes Are Associated With an Increased Likelihood of Inducible Myocardial Ischemia Among Patients With Subclinical Atherosclerosis Diabetes Care, June 1, 2005; 28(6): 1445 - 1450. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. C. Nelson, R. A. Kronmal, J. J. Carr, M. F. McNitt-Gray, N. D. Wong, C. M. Loria, J. G. Goldin, O. D. Williams, and R. Detrano Measuring Coronary Calcium on CT Images Adjusted for Attenuation Differences Radiology, May 1, 2005; 235(2): 403 - 414. [Abstract] [Full Text] [PDF]
|
|
|
|
