Predictive value of coronary calcifications for future cardiac events in asymptomatic individuals

Background Reliable risk stratification is crucial for efficient prevention of coronary artery disease. The following prospective study determined the predictive value of coronary calcifications for future cardiovascular events. Methods We included 1726 asymptomatic individuals (1018 men, 708 women, age 57.7 ± 13.3 years) referred for a cardiological examination. Coronary calcifications were determined with the Imatron C 150 XP electron beam computed tomography scanner. For quantification of coronary calcifications, we calculated the Agatston score. Over a mean observation period of 40.3 ± 7.3 months we registered the event rate for cardiac death (CD) and myocardial infarction (MI). Results The Agatston score in patients who died of CD (n = 65) or had an MI (n = 114) was significantly higher compared with those without cardiac events (458 ± 228 vs 206 ± 201, P < .01). An Agatston score above the 75th percentile was associated with a significantly higher annualized event rate for MI (3.6% vs 1.6%, P < .05) and for CD (2.2% vs 0.9%) compared with patients with scores below the 75th percentile. No cardiac events were observed in patients where coronary calcifications could be excluded. Conclusions By determination of coronary calcifications, patients at risk for future MI and CD could be identified within an asymptomatic population independent of concomitant risk factors. At the same time, future cardiovascular events could be excluded in patients without coronary calcifications.