Skip to main content
SpringerLink
Log in

Prognostic value of electron-beam computed tomography-derived coronary calcium scores compared with clinical parameters in patients evaluated for coronary artery disease

Prognostic value of EBCT in symptomatic patients

Prognostische Wertigkeit der elektronenstrahltomographischen Kalkscorebestimmung im Vergleich mit klinischen Parametern bei Patienten mit KHK-Verdacht

  • ORIGINAL PAPER
  • Published:
Zeitschrift für Kardiologie Aims and scope Submit manuscript

Zusammenfassung.

Das mittels Elektronenstrahltomographie (EBT) nichtinvasiv gemessene Ausmaß der Koronarsklerose ist als wichtiger prognostischer Faktor bei symptomatischen Patienten beschrieben worden. Die isolierte Analyse der EBT-Befunde lässt jedoch keine klinisch sinnvolle Aussage über den möglichen Stellenwert der Methode zu, und klinische Tests wie Risikofaktorenanalyse, Belastungs-EKG und Koronarangiographie liefern ihrerseits wichtige prognostische Information. Wir kontaktierten 300 Patienten, die wegen KHK-verdächtiger Symptomatik untersucht worden waren und alle auch ein EBT erhielten, 3,5 Jahre später. Komplette Follow-Up Information war für 255 (85%) verfügbar (Eingangsalter 58±11 Jahre, 71% Männer). Es wurden 4 klinische Risikokategorien unterschieden: (1) ≤1 kausaler Risikofaktor, (2) Ischämienachweis im Belastungstest oder ≥2 Risikofaktoren, (3) angiographisch nach-gewiesene KHK, (4) Koronarintervention/Operation im Rahmen der Erstabklärung. Follow-Up Ereignisse wurden bei 40 Patienten beobachtet: Progression der KHK (PTCA/Stent/OP) (n = 35), Myokardinfarkt (n = 2), Herztod (n = 3) (insgesamt bezeichnet als MACE, major adverse cardiac events). Die 4 klinischen Kategorien waren hochsignifikante Prädiktoren von MACE. Das relative Risiko stieg von 1 in Gruppe (1) auf 1,5 in (2), 6,8 in (3) und 28,3 in (4). In univariater Analyse bedeutete ein EBT-Kalkscore >100 (n = 105) ein relatives Risiko von 12,0 (95% CI, 4,7–30,6). Nach Adjustierung für den EBT-Kalkscore und für das Alter lag das relative Risiko der klinischen Kategorien in (2) bei 1,3, in (3) bei 3,6 und in (4) bei 12,0. Das adjustierte relative Risiko eines EBT-Kalkscore >100 betrug 4,4 (95% CI, 1,5–12,6). Die gängigen klinischen Parameter erlauben eine prognostische Einschätzung von symptomatischen Patienten. Die EBT-Untersuchung der Koronarsklerose ist ein davon unabhängiger prognostischer Faktor und verbessert die prognostische Einschätzung.

Summary.

Objective:

The electron-beam computed tomography-(EBCT-)derived calcium score provides a measure of coronary atherosclerotic plaque disease which may allow for more precise risk stratification in symptomatic patients. However, it remains unclear if EBCT can add prognostic information compared with the clinical information derived from risk factor assessment, exercise stress testing, and coronary angiography.

Methods and results:

A cohort of 300 consecutive patients with recent (<3 months) onset of symptoms was retrospectively identified who were examined for possible coronary artery disease (CAD) and who all underwent EBCT. Successful follow-up after 3.5 years was obtained in 255 (85%) patients whose mean age at baseline was 58±11 years (n = 181 (71%), males). Four clinical categories with increasing evidence of CAD were constructed on the basis of risk factor assessment, exercise stress testing, coronary angiographic anatomy, and coronary revascularization at baseline. During follow-up, major adverse cardiac events (MACE: myocardial infarction, cardiac death, revascularization) were observed in 40 (16%) patients, including myocardial infarction and cardiac death in 5 patients. The 4 clinical categories were highly predictive of MACE, with a relative risk estimate of 28.3 (95% CI, 6.7–119.1) in the upper vs. the reference category. In univariate analysis, the relative risk estimate of MACE associated with a calcium score ≥100 was 12.0 (95% CI, 4.7–30.6). After adjustment for the clinical categories and for age, this estimate decreased in multivariate analysis, but remained predictive at 4.4 (95% CI, 1.5–12.6).

Conclusion:

In patients with first-time evaluation of possible CAD, EBCT-derived coronary calcium is suggested to provide for independent and additional information compared with the clinically available information.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Achenbach S, Ropers D, Möhlenkamp S et al (2001) Variability of repeated coronary artery calcium measurements by electron beam tomography. Am J Cardiol 87:210–213

    Article  CAS  PubMed  Google Scholar 

  2. Achenbach S, Schmermund A, Erbel R et al (2003) Klinische Bedeutung des quantitativen Nachweises von Koronarkalk mit Elektronenstrahltomographie (EBT) und Mehrzeilen-Spiral-Computertomographie (MSCT). Z Kardiol 92:899–907

    Article  CAS  PubMed  Google Scholar 

  3. Adamzik M, Schmermund A, Reed JE et al (1999) Comparison of two different software systems for electronbeam CT-derived quantification of coronary calcification. Invest Radiol 34:767–773

    Google Scholar 

  4. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832

    CAS  PubMed  Google Scholar 

  5. Arad Y, Spadaro LA, Goodman K, Newstein D, Guerci AD (2000) Prediction of coronary events with electron beam computed tomography. J Am Coll Cardiol 36:1253–1260

    Article  CAS  PubMed  Google Scholar 

  6. Bielak LF, Sheedy PF II, Peyser PA (2001) Coronary artery calcification measured at electron-beam CT: agreement in dual scan runs and change over time. Radiology 218:224–229

    CAS  PubMed  Google Scholar 

  7. De Backer G, Ambrosioni E, Borch-Johnsen K et al (2003) Executive summary. European guidelines on cardiovascular disease prevention in clinical practice. Third joint task force of european and other societies on cardiovascular disease prevention in clinical practice. Eur Heart J 24:1601–1610

    Article  PubMed  Google Scholar 

  8. Detrano R, Hsiai T, Wang S et al (1996) Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary angiography. J Am Coll Cardiol 27:285–290

    Article  CAS  PubMed  Google Scholar 

  9. Downs JR, Clearfield M, Weis S et al (1998) Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/Tex-CAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA 279:1615–1622

    Article  CAS  PubMed  Google Scholar 

  10. Fletcher GF, Balady G, Froelicher VF, Hartley LH, Haskell WL, Pollock ML (1995) Exercise standards: a statement for healthcare professionals from the committee on exercise and cardiac rehabilitation. American Heart Association. Circulation 91:912–921

    CAS  PubMed  Google Scholar 

  11. Friedewald WT, Levy RI, Fredrickson DS (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge. Clin Chem 18:499–502

    CAS  PubMed  Google Scholar 

  12. Gibbons RJ, Chatterjee K, Daley J et al (1999) ACC/AHA/ACP—ASIM guidelines for the management of patients with chronic stable angina: a report of the american college of cardiology/american heart association task force on practice guidelines (committee on management of patients with chronic stable angina). J Am Coll Cardiol 33:2092–2197

    Article  CAS  PubMed  Google Scholar 

  13. Guerci AD, Sparado LA, Popma JJ et al (1997) Relation of coronary calcium score by electron beam computed tomography to arteriographic findings in asymptomatic and symptomatic adults. Am J Cardiol 79:128–133

    Article  CAS  PubMed  Google Scholar 

  14. Guerci AD, Sparado LA, Goodman KJ et al (1998) Comparison of electron beam computed tomography scanning and conventional risk factor assessment for the prediction of angiographic coronary artery disease. J Am Coll Cardiol 32:673–679

    Article  CAS  PubMed  Google Scholar 

  15. Haberl R, Becker A, Lang C et al (2001) Ausschluss von Koronarkalk mit Elektronenstrahltomographie: Geeignet als Filter vor invasiver Diagnostik bei symptomatischen Patienten? Z Kardiol 90:21–27

    Article  CAS  PubMed  Google Scholar 

  16. Kajinami K, Seki H, Takekoshi N, Mabuchi H (1995) Noninvasive prediction of coronary atherosclerosis by quantification of coronary artery calcification using electron beam computed tomography: comparison with electrocardiographic and thallium exercise stress test results. J Am Coll Cardiol 26:1209–1221

    Article  CAS  PubMed  Google Scholar 

  17. Keelan PC, Bielak LF, Ashai K et al (2001) Long-term prognostic value of coronary calcification detected by electron beam computed tomography in patients undergoing coronary angiography. Circulation 104:412–417

    CAS  PubMed  Google Scholar 

  18. Kennedy J, Shavelle R, Wang S, Budoff M, Detrano RC (1998) Coronary calcium and standard risk factors in symptomatic patients referred for coronary angiography. Am Heart J 135:696–702

    CAS  PubMed  Google Scholar 

  19. Möhlenkamp S, Lehmann N, Schmermund A et al (2003) Prognostic value of extensive coronary calcium quantities in symptomatic males—a 5-year follow-up study. Eur Heart J 24:845–854

    Article  PubMed  Google Scholar 

  20. Möhlenkamp S, Schmermund A, Kerkhoff G, Budde T, Erbel R (2003) Prognostische Wertigkeit der nichtinvasiv bestimmten koronaren Plaquelast bei Patienten mit Risikofaktoren. Z Kardiol 92:351–361

    Article  PubMed  Google Scholar 

  21. O’Rourke RA, Brundage BH, Froelicher VF et al (2000) American college of cardiology/american heart association expert consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. J Am Coll Cardiol 36:326–340

    Article  CAS  PubMed  Google Scholar 

  22. Park R, Detrano R, Xiang M, Fu P, Ibrahim Y, LaBree L, Azen S (2002) Combined use of computed tomography coronary calcium scores and C-reactive protein levels in predicting cardiovascular events in nondiabetic individuals. Circulation 106:2073–2077

    Article  CAS  PubMed  Google Scholar 

  23. Raggi P, Callister TQ, Cooil B et al (2000) Identification of patients at increased risk of first unheralded acute myocardial infarction by electronbeam computed tomography. Circulation 101:850–855

    CAS  PubMed  Google Scholar 

  24. Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS (1995) Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. Circulation 92:2157–2162

    CAS  PubMed  Google Scholar 

  25. Rumberger JA, Sheedy PF, Breen JF, Schwartz RS (1997) Electron beam computed tomographic coronary calcium score cutpoints and severity of associated angiographic lumen stenosis. J Am Coll Cardiol 29:1542–1548

    Article  CAS  PubMed  Google Scholar 

  26. Rumberger JA, Brundage BH, Rader DJ, Kondos G (1999) Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc 74:243–252

    CAS  PubMed  Google Scholar 

  27. Sacks FM, Tonkin AM, Shepherd J et al (2000) Effect of pravastatin on coronary disease events in subgroups defined by coronary risk factors: the prospective pravastatin pooling project. Circulation 102:1893–1900

    CAS  PubMed  Google Scholar 

  28. Schmermund A, Baumgart D, Görge G et al (1998) Measuring the effect of risk factors on coronary atherosclerosis: coronary calcium score vs angiographic disease severity. J Am Coll Cardiol 31:1267–1273

    Article  CAS  PubMed  Google Scholar 

  29. Schmermund A, Denktas AE, Rumberger JA et al (1999) Independent and incremental value of coronary artery calcium for predicting the extent of angiographic coronary artery disease: comparison with cardiac risk factors and radionuclide perfusion imaging. J Am Coll Cardiol 34:777–786

    Article  CAS  PubMed  Google Scholar 

  30. Schmermund A, Baumgart D, Sack S et al (2000) Assessment of coronary calcification by electron-beam computed tomography in symptomatic patients with normal, abnormal, or equivocal exercise stress test. Eur Heart J 21:1674–1682

    Article  CAS  PubMed  Google Scholar 

  31. Schmermund A, Schwartz RS, Adamzik M et al (2001) Coronary atherosclerosis in unheralded sudden coronary death under age fifty: histopathologic comparison with “healthy” subjects dying out of hospital. Atherosclerosis 155:499–508

    Article  CAS  PubMed  Google Scholar 

  32. Schmermund A, Erbel R (2001) Current perspective: unstable coronary plaque and its relation to coronary calcium. Circulation 104:1682–1687

    CAS  PubMed  Google Scholar 

  33. Shavelle DM, Budoff MJ, LaMont DH, Shavelle RM, Kennedy JM, Brundage BH (2000) Exercise testing and electron beam computed tomography in the evaluation of coronary artery disease. J Am Coll Cardiol 36:32–38

    Article  CAS  PubMed  Google Scholar 

  34. Shaw LJ, Raggi P, Schisterman E, Berman DS, Callister TQ (2003) Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology 228:826–833

    PubMed  Google Scholar 

  35. Third Report of the National Cholesterol Education Program (NCEP) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation 106:3143–3421

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, University Clinic Essen, Hufelandstraße 55, 45122, Essen, Germany

    A. Schmermund

  2. Institute for Medical Informatics Biometry and Epidemiology, University Clinic Essen, Essen, Germany

    A. Stang

  3. Department of Cardiology, University Clinic Essen, Essen, Germany

    S. Möhlenkamp,  H. Eggebrecht,  D. Baumgart,  V. Gilbert &  R. Erbel

  4. Institute for Micro Therapy, Bochum, Germany

    D. Grönemeyer

  5. Department of Radiology and Micro Therapy, University Witten/Herdecke, Witten/Herdecke, Germany

    D. Grönemeyer &  R. Seibel

  6. Institute for Diagnostic and Interventional Radiology, Mühlheim, Germany

    R. Seibel

Authors
  1. A. Schmermund
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Stang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Möhlenkamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Eggebrecht
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Baumgart
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. V. Gilbert
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D. Grönemeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. R. Seibel
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. R. Erbel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Schmermund.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schmermund, A., Stang, A., Möhlenkamp, S. et al. Prognostic value of electron-beam computed tomography-derived coronary calcium scores compared with clinical parameters in patients evaluated for coronary artery disease. Z Kardiol 93, 696–705 (2004). https://doi.org/10.1007/s00392-004-0120-2

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-004-0120-2

Schlüsselwörter

Key words

Search

Navigation