Mitral annular calcification: a marker of severe coronary artery disease in patients under 65 years old.

BACKGROUND Mitral annular calcification has been associated with various systemic and cardiac diseases, with a higher prevalence in women and patients over 70. A possible association between mitral annular calcification and coronary artery disease has recently been suggested. OBJECTIVE To determine the prevalence of severe coronary artery disease in younger patients with mitral annular calcification. METHODS Consecutive patients aged or= 70% stenosis of at least one major epicardial coronary artery. PATIENTS 17 735 patients were screened. Of these, 6207 (35%) had mitral annular calcification and 885 (5%) were also <or= 65 years old; coronary angiography was done in 100 of the latter (64 men; 36 women), mainly for anginal symptoms or a positive stress test. A control group (n = 121; 88 men, 33 women) was identified from 2840 consecutive patients screened. There was no significant difference between the groups in patient characteristics, indication for angiography, or atherosclerotic risk factors. RESULTS Angiography showed a higher prevalence of severe coronary artery disease in patients with mitral annular calcification than in those without (88% v 68%, p = 0.0004), and a higher prevalence of left main coronary artery disease (14% v 4%, p = 0.009) and triple vessel disease (54% v 33%, p = 0.002). The positive predictive value of mitral annular calcification for finding severe coronary artery disease was 92%. CONCLUSIONS In patients aged <or= 65 years, mitral annular calcification is associated with an increased prevalence of severe obstructive coronary artery disease. It may serve as a useful echocardiographic marker for the presence of obstructive coronary artery disease, especially when associated with anginal symptoms.