PROGNOSTIC-SIGNIFICANCE OF CARDIAC CINEFLUOROSCOPY FOR CORONARY CALCIFIC DEPOSITS IN ASYMPTOMATIC HIGH-RISK SUBJECTS

Objectives. This research investigated the prognostic signifi- cance of radiographically detectable coronary calcific deposits. Background. Coronary calcific deposits are almost always associated with coronary atherosclerosis. We investigated the association between fluoroscopically determined coronary calcium and coronary heart disease end points at 1 year of follow-up. Methods. This prospective population-based cohort study was conducted in the suburbs of Los Angeles. Fourteen hundred sixty one asymptomatic adults with an estimated greater than or equal to 10% risk of having a coronary heart disease event within 8 years underwent cardiac cinefluoroscopy for assessment of coronary calcium at initiation of the study. Clinical status including angina, docu mented myocardial infarction, myocardial revascularization and death from coronary heart disease were determined after 1 year. Results. The prevalence of calcific deposits was high (47%). A follow up examination at 1 year was successfully completed in 99.9% of subjects. Six subjects (0.4%) had died from coronary heart disease and 9 (0.6%) had had a nonfatal myocardial infarction. Thirty seven subjects (2.5%) reported angina pectoris, and 13 (0.9%) had undergone myocardial revascularization. Fifty-three subjects had at least one event during the 1 year period. Radiographically detectable calcium was associated with the presence of at least one of these end points, with a risk ratio of 2.7 (confidence limits 1.4, 4.6). The presence of coronary calcium was an independent predictor of at least one end point when controlling for age, gender and risk factors. However, three deaths due to coronary heart disease and two nonfatal myocardial infarctions occurred in subjects without detectable coronary calcium. Conclusions. The presence of coronary calcific deposits incurs an increased risk of coronary heart disease events in asymptomatic high risk subjects at 1 year. This increased risk is independent of that incurred by standard risk factors.