Neutralizing the Adverse Prognosis of Coronary Artery Calcium

被引:4
作者
Bhatti, Salman K. [1 ,2 ]
DiNicolantonio, James J. [1 ]
Captain, Becky K. [1 ]
Lavie, Carl J. [3 ,4 ]
Tomek, Ales [5 ,6 ]
O'Keefe, James H. [1 ,2 ]
机构
[1] St Lukes Mid Amer Heart Inst, Kansas City, MO 64111 USA
[2] Univ Missourie Kansas City, Sch Med, Dept Internal Med, Kansas City, MO USA
[3] Univ Queensland, Sch Med, Ochsner Clin Sch, John Ochsner Heart & Vasc Inst, New Orleans, LA USA
[4] Louisiana State Univ Syst, Pennington Biomed Res Ctr, Dept Prevent Med, Baton Rouge, LA USA
[5] Charles Univ Prague, Fac Med 2, Dept Neurol, Prague, Czech Republic
[6] Univ Hosp, Motol, Czech Republic
关键词
HEART-DISEASE; CARDIOVASCULAR RISK; ASYMPTOMATIC ADULTS; TASK-FORCE; CARDIOLOGY; MARKERS; STRESS; PLAQUE;
D O I
10.1016/j.mayocp.2013.05.019
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: To report and compare the outcomes and survival of patients with abnormal computed tomography-derived coronary artery calcium (CT-CAC) scores undergoing aggressive medical treatment at a cardiac prevention clinic. Patients and Methods: We conducted a retrospective analysis of 849 patients with intermediate risk based on the Framingham risk score and an abnormal CT-CAC score who were aggressively treated in a preventive cardiology risk factor modification program from June 23, 2000, to September 1, 2012. The primary outcome was a composite end point of myocardial infarction, resuscitated cardiac arrest, revascularization, and cardiovascular death. The effect of the CT-CAC subgroup on major adverse coronary heart disease events (MACEs) was evaluated by calculating hazard ratios with Cox proportional hazards regression modeling. The Centers for Disease Control and Prevention Wonder database was used to identify age- and sex-matched controls from the general population of Kansas and Missouri. Results: The mean age of the study patients was 65.4 years (58.4% men [496]). The median follow-up was 58 months, and the mean CT-CAC score was 336 Agatston units. Thirty-four patients (4.0%) reached the primary end point, including 4 deaths. The adjusted 10-year mortality rates were similar in the study group and control group (9.3 vs 10.6; P=.80). After adjustment, a CT-CAC score greater than 400 Agatston units correlated with a higher risk of MACEs (hazard ratio, 3.55; P=.01). Conclusion: These results suggest that intermediate-risk patients with abnormal CT-CAC scores when treated with intensive risk factor reduction have lower rates of MACEs than predicted by the Framingham risk score and the presence of coronary artery calcium. (c) 2013 Mayo Foundation for Medical Education and Research
引用
收藏
页码:806 / 812
页数:7
相关论文
共 19 条
[11]  
Greenland P, 2010, J AM COLL CARDIOL, V56, pE50, DOI 10.1016/j.jacc.2010.09.001
[12]   Evaluation of Newer Risk Markers for Coronary Heart Disease Risk Classification A Cohort Study [J].
Kavousi, Maryam ;
Elias-Smale, Suzette ;
Rutten, Joost H. W. ;
Leening, Maarten J. G. ;
Vliegenthart, Rozemarijn ;
Verwoert, Germaine C. ;
Krestin, Gabriel P. ;
Oudkerk, Matthijs ;
de Maat, Moniek P. M. ;
Leebeek, Frank W. G. ;
Mattace-Raso, Francesco U. S. ;
Lindemans, Jan ;
Hofman, Albert ;
Steyerberg, Ewout W. ;
van der Lugt, Aad ;
van den Meiracker, Anton H. ;
Witteman, Jacqueline C. M. .
ANNALS OF INTERNAL MEDICINE, 2012, 156 (06) :438-U88
[13]   Review of Radiation Reduction Strategies in Clinical Cardiovascular Imaging [J].
Koshy, Sindhu ;
Thompson, Randall C. .
CARDIOLOGY IN REVIEW, 2012, 20 (03) :139-144
[14]   Potential Clinical and Economic Consequences of Noncardiac Incidental Findings on Cardiac Computed Tomography [J].
MacHaalany, Jimmy ;
Yam, Yeung ;
Ruddy, Terrence D. ;
Abraham, Arun ;
Chen, Li ;
Beanlands, Rob S. ;
Chow, Benjamin J. W. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2009, 54 (16) :1533-1541
[15]   From vulnerable plaque to vulnerable patient - Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) task force report [J].
Naghavi, Morteza ;
Falk, Erling ;
Hecht, Harvey S. ;
Jamieson, Michael J. ;
Kaul, Sanjay ;
Berman, Daniel ;
Fayad, Zahi ;
Budoff, Matthew J. ;
Rumberger, John ;
Naqvi, Tasneem Z. ;
Shaw, Leslee J. ;
Faergeman, Ole ;
Cohn, Jay ;
Bahr, Raymond ;
Koenig, Wolfgang ;
Demirovic, Jasenka ;
Arking, Dan ;
Herrera, Victoria L. M. ;
Badimon, Juan ;
Goldstein, James A. ;
Rudy, Yoram ;
Airaksinen, Juhani ;
Schwartz, Robert S. ;
Riley, Ward A. ;
Mendes, Robert A. ;
Douglas, Pamela ;
Shah, Prediman K. .
AMERICAN JOURNAL OF CARDIOLOGY, 2006, 98 (2A) :2H-15H
[16]   Coronary Artery Calcium in Relation to Initiation and Continuation of Cardiovascular Preventive Medications The Multi-Ethnic Study of Atherosclerosis (MESA) [J].
Nasir, Khurram ;
McClelland, Robyn L. ;
Blumenthal, Roger S. ;
Goff, David C., Jr. ;
Hoffmann, Udo ;
Psaty, Bruce M. ;
Greenland, Philip ;
Kronmal, Richard A. ;
Budoff, Matthew J. .
CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES, 2010, 3 (03) :228-235
[17]  
Reilly SD, 2008, TEX HEART I J, V35, P99
[18]   Guideline for minimizing radiation exposure during acquisition of coronary artery calcium scans with the use of multidetector computed tomography [J].
Voros, Szilard ;
Rivera, Juan J. ;
Berman, Daniel S. ;
Blankstein, Ron ;
Budoff, Matthew J. ;
Cury, Ricardo C. ;
Desai, Milind Y. ;
Dey, Damini ;
Halliburton, Sandra S. ;
Hecht, Harvey S. ;
Nasir, Khurram ;
Santos, Raul D. ;
Shapiro, Michael D. ;
Taylor, Allen J. ;
Valeti, Uma S. ;
Young, Phillip M. ;
Weissman, Gaby .
JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY, 2011, 5 (02) :75-83
[19]   Comparison of Novel Risk Markers for Improvement in Cardiovascular Risk Assessment in Intermediate-Risk Individuals [J].
Yeboah, Joseph ;
McClelland, Robyn L. ;
Polonsky, Tamar S. ;
Burke, Gregory L. ;
Sibley, Christopher T. ;
O'Leary, Daniel ;
Carr, Jeffery J. ;
Goff, David C., Jr. ;
Greenland, Philip ;
Herrington, David M. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2012, 308 (08) :788-795