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Prognostic value of coronary electron-beam computed tomography for coronary heart disease events in asymptomatic
P G O'Malley1, A J Taylor, J L Jackson
1General Internal Medicine Service, Walter Reed Army Medical Center, Washington, DC, USA. patrick.omalley@na.amedd.army.mil
Insights
Electron-beam computed tomography (EBCT) shows promise in predicting coronary heart disease events in asymptomatic individuals. However, caution is advised due to study heterogeneity, necessitating further research on its incremental value.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- The prognostic value of electron-beam computed tomography (EBCT) for coronary heart disease (CHD) in asymptomatic individuals is debated.
- Hard coronary outcomes include myocardial infarction and cardiac death.
Purpose of the Study:
- To systematically review and meta-analyze data on EBCT's ability to predict cardiovascular prognosis in asymptomatic populations.
- To assess EBCT's predictive accuracy for hard coronary events and combined outcomes.
Main Methods:
- Systematic review and meta-analysis of published studies.
- Inclusion of studies reporting relative risk for myocardial infarction, sudden death, or revascularization.
- Synthesis of prognostic data using meta-analytic techniques.
Main Results:
- A calcium score above the median was associated with an increased risk of combined outcomes (nonfatal myocardial infarction, death, or revascularization) (summary risk ratio 8.7).
- A significantly increased risk for hard events (myocardial infarction or death) was observed (summary risk ratio 4.2).
- Significant heterogeneity was noted across study quality and patient populations.
Conclusions:
- EBCT appears to predict combined and hard coronary outcomes in high-risk asymptomatic populations.
- Results should be interpreted cautiously due to significant heterogeneity in study quality and populations.
- Further research is required to determine EBCT's incremental value over conventional risk prediction for screening asymptomatic individuals.
Abstract:
The predictive ability of electron-beam computed tomography (EBCT) for coronary heart disease outcomes, particularly hard coronary outcomes (myocardial infarction or death), has been questioned in asymptomatic populations. Our objective was to synthesize data on the use of EBCT for determining cardiovascular prognosis in asymptomatic populations. Studies were identified using standard systematic review methods. The outcome of interest was relative risk for myocardial infarction or sudden death, and combined events including revascularization. Nine articles met the inclusion criteria, of which 5 were of independent studies. Using meta-analytic techniques to synthesize prognostic data, there was an increased risk (summary risk ratio 8.7, 95% confidence interval 2.7 to 28.1) of a combined outcome of nonfatal myocardial infarction or death or revascularization if the calcium score was above a median score. Similarly, there was an increased risk for hard events: myocardial infarction or death (summary risk ratio 4.2, 95% confidence interval 1.6 to 11.3). However, there was significant heterogeneity in the studies' quality and patient populations. Although EBCT appears to predict combined and hard coronary outcomes similarly in high risk, asymptomatic populations, these results should be interpreted with caution. Further study is needed on the incremental value of EBCT over conventional risk prediction before this test is used in screening asymptomatic populations.