Author + information
- Michael Donovan1,
- Rolf Graning1,
- Bradley Serwer2,
- Anjeanette Benjamin1,
- Scott Hopkins1,
- John Thurber1 and
- Michael Ferguson1
A quantitative association between pre-procedural coronary artery calcium (CAC) and revascularization outcomes has yet to be described. The objective of this study was to determine the association between pre-procedural CAC and major adverse cardiovascular events (MACE) after patients have undergone revascularization via percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
Seventy-three patients were enrolled in a retrospective cohort who underwent CAC scoring via Electron Beam or Multi-detector Computerized Tomography prior to surgical or percutaneous revascularization. CAC scoring was computed using Agatston’s method. MACE was defined as cardiovascular death, myocardial infarction or target vessel revascularization (TVR). Medians were compared using the Mann-Whitney test with significance defined at p<0.05. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for TVR using Fisher’s exact method. Multivariate analysis was performed to identify independent associations for MACE. Follow-up was obtained via our electronic health record.
745 PCI’s and 279 CABG’s were reviewed over a six year period from 2005-2010. 38 PCI and 35 CABG patients met inclusion criteria. For the PCI cohort, 54 vessels were stented, median age was 60 years, median follow-up was 37 months and 8 patients suffered MACE. The median CAC score was 622 for those who experienced MACE versus 188 without MACE (p=0.03). For the CABG cohort, 95 vessels were grafted, median age was 64 years, median follow-up was 30 months and 6 patients suffered MACE. The median CAC score was 1524 for those who experienced MACE versus 434 without MACE (p=0.01). Patients with a CAC score > 400 were more likely to undergo TVR after PCI (OR=6.0, 95% CI 1.02-35.34, p=0.04), but not CABG (OR=2.14, 95% CI 0.33-13.58, p=0.65). CAC scores were not independently associated with MACE for either CABG or PCI patients on a multivariate analysis including CAC, age, hypertension, diabetes mellitus, hyperlipidemia, stent diameter, or stent length.
This data supports the association of elevated CAC scores and MACE following revascularization in both PCI and surgical patients. Elevated CAC scores > 400 were associated with TVR in the PCI group, but not in the CABG group. Increased CAC score was not found to be an independent predictor of MACE. Further investigation with a larger study population is warranted to determine independent predictors of MACE following revascularization in patients with elevated CAC scores.