Coronary Artery Calcium to Predict All-Cause Mortality in Elderly Men and Women

Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Journal of the American College of Cardiology (Impact Factor: 15.34). 07/2008; 52(1):17-23. DOI: 10.1016/j.jacc.2008.04.004
Source: PubMed

ABSTRACT We sought to study the prognostic utility of coronary artery calcium (CAC) in the elderly.
The prognostic significance of CAC in the elderly is not well known.
All-cause mortality was assessed in 35,388 patients (3,570 were >or=70 years old at screening, and 50% were women) after a mean follow-up of 5.8 +/- 3 years.
In older patients, risk factors and CAC were more prevalent. Overall survival was 97.9% at the end of follow-up. Mortality increased with each age decile with a relative hazard of 1.09 (95% confidence interval: 1.08 to 1.10, p < 0.0001), and rates were greater for men than women (hazard ratio: 1.53; 95% confidence interval: 1.32 to 1.77, p < 0.0001). Increasing CAC scores were associated with decreasing survival across all age deciles (p < 0.0001). Survival for a <40-year and >or=80-year-old man with a CAC score >or=400 was 88% and 19% (95% and 44% for a woman, p < 0.0001), respectively. Among the 20,562 patients with no CAC, annual mortality rates ranged from 0.3% to 2.2% for patients age 40 to 49 years or >or=70 years (p < 0.0001). The use of CAC allowed us to reclassify more than 40% of the patients >or=70 years old more often by excluding risk (i.e., CAC <400) in those with >3 risk factors.
Despite their limited life expectancy, the use of CAC discriminates mortality risk in the elderly. Furthermore, the use of CAC allows physicians to reclassify risk in the elderly.

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