Electron beam computed tomography screening of the coronary arteries: experience with 3,263 patients at Walter Reed
I M Feuerstein1, M P Brazaitis, J M Zoltick
1Department of Radiology, Room 1X05B, Building 2 (Heaton Pavilion), Walter Reed Army Medical Center, 3900 Georgia Avenue NW, Washington, DC 20307, USA. irwin.feuerstein@na.amedd.army.mil
Insights
Electron beam computed tomography (EBCT) reveals significant coronary artery calcification in military personnel and dependents. Many individuals, particularly older men, show high scores indicating advanced coronary artery disease.
Area of Science:
- Cardiovascular Imaging
- Preventive Cardiology
- Radiology
Background:
- Coronary atherosclerosis poses a significant health burden to Department of Defense populations.
- Noninvasive imaging of coronary arteries is crucial for early detection and management.
- Electron beam computed tomography (EBCT) offers direct visualization of coronary arteries.
Purpose of the Study:
- To assess the prevalence and severity of coronary calcification in a military cohort using EBCT.
- To identify demographic associations (age, gender) with coronary artery calcium scores.
- To evaluate the utility of EBCT in identifying individuals at risk for coronary artery disease within the military community.
Main Methods:
- A retrospective analysis of 3,263 patients scanned with EBCT between August 1997 and February 1999 at Walter Reed Army Medical Center.
- Data collection included patient demographics and EBCT-derived coronary artery calcium scores.
- Statistical analysis focused on the association of age and gender with calcification prevalence and severity.
Main Results:
- Coronary calcification was detected in 46% of patients, with scores strongly associated with age and male gender.
- Average scores increased exponentially with age, doubling approximately every 7 years.
- Significant proportions of men in their 40s (8%) through 70s (49%) presented with high coronary artery calcium scores, indicating advanced disease.
Conclusions:
- A substantial prevalence of coronary artery calcification exists within the military population and their dependents.
- EBCT effectively identifies individuals with occult calcific coronary atherosclerosis.
- EBCT should be a key tool for risk stratification and early detection of coronary artery disease in this population.
Abstract:
The U.S. Department of Defense desires to reduce the impact of coronary atherosclerosis on its active duty, retired, and dependent populations. Electron beam computed tomography (EBCT) is currently the best way to noninvasively image the coronary arteries directly. Between August 1997 and February 1999, a total of 3,263 patients were scanned by EBCT in the Radiology Department at Walter Reed Army Medical Center. Scans were performed on 2,415 men (74%) and 848 women (26%). The most common age group was 50 to 54 years (25%). Coronary calcification was found in approximately half of the patients (46%), and the magnitude of the score was strongly associated with age and male gender. Average scores increased exponentially with age, doubling every 7 years. In men, average scores ranged from 17 units in those aged 35 to 39 years to 842 in those older than 70 years old. In women, average scores ranged from 1 in those 35 to 39 years to 162 in those older than 70 years. Significant numbers of patients fell into the high-risk categories, with 8% of men in their 40s, 20% of men in their 50s, 33% of men in their 60s, and 49% of men in their 70s with high scores. Scores of more than 400 units were seen in 368 patients (8%) overall. There is a large amount of coronary calcium present in military personnel and their dependents, in patterns that are consistent with previous studies. Many patients had very high scores that are consistent with advanced coronary artery disease. EBCT should play a central role in the identification of occult calcific atherosclerosis of the coronary arteries in military, retired, and dependent patients.
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