PROGNOSTIC-SIGNIFICANCE OF CORONARY CALCIFIC DEPOSITS IN ASYMPTOMATICHIGH-RISK SUBJECTS

PURPOSE: TO determine the predictive value of coronary calcifications for coronary heart disease events in high-risk, asymptomatic adults. P ATIENTS AND METHODS: A prospective cohort study of 1,461 high-risk, as ymptomatic subjects were followed for 55 months with a 98% success rat e. Coronary risk factor assessment and cardiac fluoroscopy with digita l subtraction enhancement were performed to determine the number of ca lcified coronary arteries. RESULTS: Fifty-eight percent of this cohort (852 subjects) had fluoroscopically detectable coronary calcification : 437 (30%) had calcium in one, 253 (17%) in two, and 162 (11%) in all three coronary vessels. There were 90 (6%) deaths, 35 (39%) attributa ble to coronary heart disease, and 43 (3%) nonfatal myocardial infarct ions. Subjects with calcification in more than one major coronary arte ry were 2.2 times more likely to suffer coronary death or nonfatal inf arction (P = 0.001) than were subjects with one or no calcified arteri es. Multivariable logistic regression analysis showed that only the nu mber of calcified arteries, age, total cholesterol, history of diabete s, and left ventricular hypertrophy by electrocardiogram were associat ed independently with the incidence of coronary death or infarction in these subjects. CONCLUSIONS: Coronary calcification predicts coronary heart disease death or infarction in high-risk asymptomatic adults as well as do standard risk factors. (C) 1997 by Excerpta Medica, Inc.