Coronary Artery Calcium to Predict All-Cause Mortality in Elderly Men and Women

Objectives: We sought to study the prognostic utility of coronary artery calcium (CAC) in the elderly. Background: The prognostic significance of CAC in the elderly is not well known. Methods: All-cause mortality was assessed in 35,388 patients (3,570 were ≥70 years old at screening, and 50% were women) after a mean follow-up of 5.8 ± 3 years. Results: In older patients, risk factors and CAC were more prevalent. Overall survival was 97.9% at the end of follow-up. Mortality increased with each age decile with a relative hazard of 1.09 (95% confidence interval: 1.08 to 1.10, p < 0.0001), and rates were greater for men than women (hazard ratio: 1.53; 95% confidence interval: 1.32 to 1.77, p < 0.0001). Increasing CAC scores were associated with decreasing survival across all age deciles (p < 0.0001). Survival for a <40-year and ≥80-year-old man with a CAC score ≥400 was 88% and 19% (95% and 44% for a woman, p < 0.0001), respectively. Among the 20,562 patients with no CAC, annual mortality rates ranged from 0.3% to 2.2% for patients age 40 to 49 years or ≥70 years (p < 0.0001). The use of CAC allowed us to reclassify more than 40% of the patients ≥70 years old more often by excluding risk (i.e., CAC <400) in those with >3 risk factors. Conclusions: Despite their limited life expectancy, the use of CAC discriminates mortality risk in the elderly. Furthermore, the use of CAC allows physicians to reclassify risk in the elderly.