Dynamics of coronary calcification and its association with the clinical course of ischemic heart disease and osteopenic syndrome

Abstract

Purpose: to study the relationship between degree of calcification of coronary arteries, osteopenic syndrome, and clinical course of ischemic heart disease (IHD) during 3–5 years of follow-up in men after coronary artery bypass grafting (CABG). Materials and methods. We included in this prospective study 111 men admitted for CABG under cardiopulmonary bypass. All patients underwent color duplex scanning (CDS) of brachiocephalic arteries (BCA), coronary angiography, multislice computed tomography (MSCT) of coronary arteries (CAs) to assess the degree of calcification, densitometry of femoral neck. Cardiac calcium score of the vessels was assessed by the Agatston method. After 3–5 (mean 4.2) years we assessed dead or alive status of 111 patients. Mortality during followup was 11.7% (n=13). In 59 of 98 survived patients we repeated CDS of BCA and MSCT of CAs with calculation of CA calcification scores. Results. Significant CA calcification prior to CABG was detected in more than half of the patients (57.6%). Among all clinical and anamnestic factors only one risk factor – smoking was associated with mortality (odds ratio [OR] 9.8, 95% confidence interval [CI] 1.2–78.1, χ 2 =6.6, р=0.01). There were no association of mortality with index of CA calcification, Syntax score, osteopenic syndrome and BCA involvement. In the group of patients with baseline coronary calcification index >400 there were more smokers (р=0.026) and patients with lesions in >3 CAs (р=0.037) compared with the group with values ≤400. At the preoperative stage we revealed associations of CAs calcification index with T-test characterizing presence of the osteopenic syndrome (r= –0.24, р=0.06), Syntax score (r=0.26, р=0.041), and number of affected CAs (r=0.25, р=0.048). At repeated examination 3–5 years after CABG a medium positive correlation was detected between the severity of CA calcification and the severity of BCA stenoses (r=0.28, р=0.029). Linear regression analysis with stepwise selection identified baseline (prior to CABG) higher values of T-test evaluated at femoral bone as the only significant predictor of calcium score increase during 3–5 years of follow-up. Conclusion. Dynamics of calcification of CAs in men with IHD during 3–5 years of follow-up after CABG was multidirectional, but in most cases (66%) it was progressive. There was correlation between coronary calcification and smoking status and decreased T-test assessed at femoral bone prior to CABG. In the long-term follow-up period the correlation between severity of BCA lesion and severity of coronary calcification was found. Negative correlation was detected between progression of coronary calcification and baseline impairment of mineral density of femoral bone.