High calcium scores linked to dramatic increase in coronary event risk

מתוך medicontext.co.il
By Anthony J. Brown, MD

NEW YORK (Reuters Health) – In asymptomatic individuals, high coronary calcium scores are associated with an extremely elevated risk of coronary events, according to a report published in the January 16th issue of the Journal of the American College of Cardiology.

The amount of coronary calcium is known to correlate with the total plaque burden. Yet, the prognostic significance of this calcium has been controversial with some investigators claiming that increased levels actually stabilize the plaque, making ischemic events less likely.

Dr. Paolo Raggi, from Tulane University School of Medicine in New Orleans, and colleagues assessed the coronary-related outcomes of 98 asymptomatic subjects who had calcium scores of at least 1000 on screening electron beam tomography. The subjects were followed for a mean of 17 months and underwent no further testing after the initial screen.

Just over one third of the subjects experienced myocardial infarction or coronary death during the study period. All of the events occurred within 28 months of follow-up. Subjects who experienced a coronary event had significantly higher calcium scores than those who did not (p < 0.001).

The annual coronary event rate for subjects in the current study was 25%, the researchers note. This rate was significantly higher than the 7.4% rate reported in a historical control group of patients with severe stress perfusion abnormalities (p < 0.0001).

"Researchers continue to argue about the prognostic significance of coronary calcium," Dr. Raggi told Reuters Health. "Some would claim that calcium in a plaque is a good thing because it probably represents healing of the plaque," he added. "We studied a group of subjects with very high calcium scores so that it would be easy to determine whether calcium was beneficial or not."

Dr. Raggi noted that "the patients in our study were dropping like flies. While "it is possible that we underestimated the annual event rate in the control group, even if the rate was as high as 18%, it is still much lower than that of patients with high calcium scores," he added.

"High calcium scores are not indicative of a stable patient," Dr. Raggi emphasized. "The present findings are a slap in the face to those investigators who claim calcium benefits the patient by stabilizing the vessels."

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