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To the Editor:The paper by Keelan et al1 addresses an important issue, namely how to define which patients with symptomatic coronary artery disease (CAD) are at risk for future events. They argue that coronary artery calcification (CAC) provides incremental prognostic value after clinical risk factors and coronary arteriography are included in the analysis, and indeed, only age and CAC were predictive in their model.Several issues need to be addressed before accepting this conclusion. The authors used several methods of quantifying CAC. Quartile analysis was done, but no data are provided on the number of patients at risk in each quartile, and apparently this analysis did not reach significance. Log transformation was used to analyze the data and was found significant in the Cox model. Lastly, a score of 100 formed the basis of their survival …

Long-Term Prognostic Value of Coronary Calcification Detected by Electron Beam Computed Tomography in Patients Undergoing Coronary Arteriography