© 2001 American Heart Association, Inc.
Atherosclerosis and Lipoproteins |
Natural History and Topographic Pattern of Progression of Coronary Calcification in Symptomatic Patients
An Electron-Beam CT Study
From the Department of Cardiology (A.S., D.B., S.M., R.E.), University Clinic Essen, Essen, Germany; the Institute for MicroTherapy (P.K., D.G.), Bochum, Germany; the Institute for Diagnostic and Interventional Radiology (H.P., R.S.), Mülheim, Germany; and the Department of Radiology and MicroTherapy (P.K., H.P., D.G., R.S.), University Witten/Herdecke, Witten, Germany.
Correspondence to Dr Axel Schmermund, Department of Cardiology, University Clinic Essen, Hufelandstraße 55, D-45122 Essen, Germany. E-mail Axel.Schmermund{at}uni-essen.de
Abstract—Electron-beam CT may assess the progression of coronary atherosclerosis by visualizing changes in calcification. The present investigation analyzes (1) the rate of progression of calcification in symptomatic patients, (2) the topographic pattern, and (3) the influence of baseline plaque burden and risk factors. Progression of calcification during a mean (median) interval of 18 (15) months was measured in 102 symptomatic outpatients (aged 59±9 years, 80% male) with calcification. In 4 patient groups with a baseline total score (Agatston criteria) of 1 to 30, >30 to 100, >100 to 400, and >400, the median was 3.1, 26.1, 58.9, and 109.7, respectively, for absolute annual progression of the score (P<0.05) and 57%, 49%, 32%, and 15%, respectively, for relative progression (P<0.05). On the coronary segmental level, changes were largely restricted to typical predilection sites of coronary atherosclerosis. The presence of angiographically defined coronary narrowing influenced absolute, but not relative, progression. Of the risk factors, only low density lipoprotein cholesterol levels showed a trend, although not significant, for predicting progression. These data indicate that baseline plaque burden determines the rate of progression of calcification. This appears to be a coronary systemic process, reflecting the natural history of coronary atherosclerosis.
Key Words: progression • coronary atherosclerosis • calcium • electron-beam CT • coronary artery disease
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