Prediction of coronary events with electron beam computed tomography

OBJECTIVES We sought to determine the prognostic accuracy of electron beam computed tomographic (EBCT) scanning of the coronary arteries at three to f our years. BACKGROUND Coronary artery calcium scores determined by EBCT correlate with the severity of coronary artery disease. However, previous reports of the prognostic accuracy of EBCT scanning for coronary events in asymptomatic in dividuals are conflicting. METHODS Asymptomatic men and women undergoing coronary EBCT completed initi al and follow-up evaluations, which included past medical history, the Rose angina questionnaire and interim cardiovascular events. Reported coronary events (death, nonfatal myocardial infarction [MI] and revascularization pr ocedures) were confirmed without knowledge of the scan results. RESULTS Information was obtained in 1,172 (99.6%) of 1,177 eligible subject s (baseline age 53 +/- 11 years, 71% men). During an average follow-up of 3 .6 years, 39 subjects sustained coronary events: three coronary deaths, 15 nonfatal MIs and 21 coronary artery revascularization procedures. The mean coronary artery calcium score was 764 +/- 935 among subjects with events as compared with 135 +/- 432 among those without events (p < 0.0001). For the prediction of all coronary events and of nonfatal MIs and deaths, the area s under the receiver-operator characteristics curve were 0.84 and 0.86, res pectively, and a coronary calcium score greater than or equal to 160 was as sociated with odds ratios of 15.8 and 22.2, respectively. The odds ratios f or all events remained high (14.3 to 20.2) after adjustment for self-report ed cardiovascular risk factors. CONCLUSIONS In asymptomatic adults, EBCT of the coronary arteries predicts coronary death and nonfatal MT and the need for revascularization procedure s. CT Am Coil Cardiol 2000;36:1253-60) (C) 2000 by the American College of Cardiology.