Coronary heart disease deaths and infarctions in people with little or no coronary calcium

摘要: Measurement of coronary artery calcium with electronbeam computed tomography (EBCT) has been proposed to identify people subclinical atherosclerosis. A study in patients undergoing angiography showed that a score 159 on EBCT is the optimal cutpoint discriminate those obstructive disease (at least one lesion angiographic stenosis severity >80%) from without. Despite conflicting results prospective investigations assessing prognostic capabilities scanning, it suggested negative scan virtually rules out and indicates low risk event. Can patient an less than 160 confidently be told they are at little or no event? We assessed factors measured 1196 symptomless factor but previous history disease. then noted occurrence events (death due heart non-fatal myocardial infarction) over 41 months. All were verified by blinded adjudication committee based upon examination hospital records. Over 99% individuals followed up. The mean infarction death within 3 years was 3·3%, risk-factor assessment performed time scanning calculations Framingham algorithm. Median 44, minimum 0 maximum 4576. Two-thirds had some detectable calcium. Individuals divided into equal tertiles 398 each basis score, number tertile compared. There 46 patents events: 17 35 (four fatal 29 non-fatal). Patients higher more likely suffer infarctions combined endpoint (p=0·003 0·002, respectively, table). 24 events—52% (nine deaths [53%] 14 33 [42%])—were two lowest all whom scores 152 less. sensitivity specificity for predicting 87% 32%; 151 52% 67%. conclude that, disease, half suffering have 152. Therefore, does not indicate low-risk subsequent death.