CORONARY CALCIUM AND STANDARD RISK-FACTORS IN SYMPTOMATIC PATIENTS REFERRED FOR CORONARY ANGIOGRAPHY

Objectives The purpose of this study was to compare quantitative estim ates of coronary calcification with traditional coronary risk factors to determine their independent predictive power for the diagnosis of o bstructive angiographic coronary artery disease in symptomatic patient s. Methods Three hundred sixty-eight symptomatic patients underwent co ronary angiography and electron beam computed tomography at Four diffe rent centers between April 1989 and December 1993, A blinded cardiolog ist interpreted the electron beam computed tomograms. Coronary risk Fa ctors were obtained in all 368 patients. Both bivariate and multivaria te analyses were used to investigate the relation between risk factors and angiographic disease, Results One hundred fifty-eight patients (4 3%) had angiographically obstructive coronary artery disease (>50% lum inal stenosis) and 297 (81%) had coronary calcification, At the bivari ate level, only mole sex and log-transformed coronary calcification we re predictive of angiographic disease (p = 0.008, p = 0.001), By multi variate analysis, only male sex and coronary calcification were predic tive (p = 0.001, p = 0.001). Sixty-four of the 71 patients without cor onary calcification did nor have disease, yielding a negative predicti ve value of 90%. Receiver operating characteristic curve analysis show ed that the amount of coronary calcium was a significantly better disc riminator of disease than were the other risk factors. Conclusions Cor onary calcification is a stronger predictor of angiographic coronary a rtery disease in symptomatic patients undergoing angiography than are standard risk factors.