Article

Coronary calcium as a predictor of coronary events in four racial or ethnic groups

Department of Radiological Sciences, University of California at Irvine, Irvine, CA 92697, USA.
New England Journal of Medicine (Impact Factor: 54.42). 03/2008; 358(13):1336-45. DOI: 10.1056/NEJMoa072100
Source: PubMed

ABSTRACT In white populations, computed tomographic measurements of coronary-artery calcium predict coronary heart disease independently of traditional coronary risk factors. However, it is not known whether coronary-artery calcium predicts coronary heart disease in other racial or ethnic groups.
We collected data on risk factors and performed scanning for coronary calcium in a population-based sample of 6722 men and women, of whom 38.6% were white, 27.6% were black, 21.9% were Hispanic, and 11.9% were Chinese. The study subjects had no clinical cardiovascular disease at entry and were followed for a median of 3.8 years.
There were 162 coronary events, of which 89 were major events (myocardial infarction or death from coronary heart disease). In comparison with participants with no coronary calcium, the adjusted risk of a coronary event was increased by a factor of 7.73 among participants with coronary calcium scores between 101 and 300 and by a factor of 9.67 among participants with scores above 300 (P<0.001 for both comparisons). Among the four racial and ethnic groups, a doubling of the calcium score increased the risk of a major coronary event by 15 to 35% and the risk of any coronary event by 18 to 39%. The areas under the receiver-operating-characteristic curves for the prediction of both major coronary events and any coronary event were higher when the calcium score was added to the standard risk factors.
The coronary calcium score is a strong predictor of incident coronary heart disease and provides predictive information beyond that provided by standard risk factors in four major racial and ethnic groups in the United States. No major differences among racial and ethnic groups in the predictive value of calcium scores were detected.

1 Follower
 · 
133 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The development of cardiac CT has provided a non-invasive alternative to echocardiography, exercise electrocardiogram, and invasive angiography and cardiac CT continues to develop at an exponential speed even now. The appropriate use of cardiac CT may lead to improvements in the medical performances of physicians and can reduce medical costs which eventually contribute to better public health. However, until now, there has been no guideline regarding the appropriate use of cardiac CT in Korea. We intend to provide guidelines for the appropriate use of cardiac CT in heart diseases based on scientific data. The purpose of this guideline is to assist clinicians and other health professionals in the use of cardiac CT for diagnosis and treatment of heart diseases, especially in patients at high risk or suspected of heart disease.
    Korean journal of radiology: official journal of the Korean Radiological Society 03/2015; 16(2):251-285. DOI:10.3348/kjr.2015.16.2.251 · 1.81 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Coronary artery calcification which is determined quantitatively by coronary calcium scoring has been known as a sign of coronary stenosis and thus future cardiac events; hence it has been noticed on spotlight of researchers in recent years. Developing different method for early and optimal detection of coronary artery disease (CAD) is really essential as CAD are the first cause of death in population. To evaluate predictive value of vessel specific coronary artery calcium (CAC) score in predicting obstructive coronary artery disease. In this diagnostic test study we evaluated patients with coronary computed tomography angiography (CCTA) and CAC score which had been referred to two referral radiology center in Tehran, Iran and finally we selected 2525 patients in a single and sequential pattern to create a diagnostic study. The whole-heart CAC scores and vessel specific CAC scores were calculated individually for the 4 major epicardial coronary arteries in 2 distinct group; group A ( patients with previous history of CABG) and group B (patients without history of CABG). For evaluation of obstruction tree cut off points were described: 0 > ; at least 1 segment with any kind of stenosis, ≥ 50; at least 1 segment with stenosis ≥ 50, ≥ 70; at least 1 segment with stenosis ≥ 70. Mean of coronary calcium scores in terms of each coronary artery vessel increase by increasing coronary stenosis grade in group B; LAD, RCA, LCX respectively have mean CAC score 6.06, 6.21 and 5.04 in normal patients and 221.6, 226.7 and 106.6 in patients with complete stenosis. As expected these findings don't work for group A. Also By increasing calcium score cutoff in all four vessels sensitivity decreased and specificity increased but steal LAD had higher sensitivity than other vessels and LM had higher specificity. Thus using calcium score method is useful for ruling out stenosis in LAD while calcium score of LM can predict existence of stenosis in LM. However none of the vessel specific CAC can reach to 100% sensitivity and specificity of CCTA method. CCTA is highly superior than vessel specific CAC score thus to minimize patients radiation does maybe we can eliminate CAC scan as a routinely perform procedure at the beginning of the CCTA.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The amount of coronary artery calcification (CAC) is a strong and independent predictor of cardiovascular events. We present a system that automatically quantifies total patient and per coronary artery CAC in non-contrast-enhanced, ECGtriggered cardiac CT. The system identifies candidate calcifications that cannot be automatically labeled with high certainty and optionally presents these to an expert for review. Candidates were extracted by intensity-based thresholding and described by location features derived from estimated coronary artery positions, as well as size, shape and intensity features. Next, a two-class classifier distinguished between coronary calcifications and negatives or a multiclass classifier labeled CAC per coronary artery. Candidates that could not be labeled with high certainty were identified by entropy-based ambiguity detection and presented to an expert for review and possible relabeling. The system was evaluated with 530 test images. Using the two-class classifier, the intra-class correlation coefficient (ICC) between reference and automatically determined total patient CAC volume was 0.95. Using the multiclass classifier, the ICC between reference and automatically determined per artery CAC volume was 0.98 (LAD), 0.69 (LCX), and 0.95 (RCA). In 49% of CTs, no ambiguous candidates were identified, while review of the remaining CTs increased the ICC for total patient CAC volume to 1.00, and per artery CAC volume to 1.00 (LAD), 0.95 (LCX), and 0.99 (RCA). In conclusion, CAC can be automatically identified in noncontrast- enhanced ECG-triggered cardiac CT. Ambiguity detection with expert review may enable the application of automatic CAC scoring in the clinic with a performance comparable to that of a human expert.
    03/2015; DOI:10.1109/TMI.2015.2412651

Full-text (2 Sources)

Download
61 Downloads
Available from
May 15, 2014