A review of electron beam computed tomography: implications for coronary artery disease screening

Coronary artery disease is the leading cause of death in the United States, thus the intense interest in a screening test that would allow early identification of coronary artery disease in its asymptomatic stage, allowing early aggressive targeted risk factor reduction. While office-based risk factor assessment is currently the reference standard for prediction of cardiac risk, several imaging tests are currently being investigated. Electron beam computed tomography (EBCT) can accurately identify calcium in the coronary tree noninvasively. Coronary calcium is clearly linked with coronary atherosclerosis. In population studies, populations with higher calcium scores have more calcium events. The predictive value of a calcium score for an individual is currently under investigation, as well as the incremental value of a calcium score over office-based risk assessment in cardiac risk prediction. This review looks at the current role of EBCT in the prevention of cardiovascular disease. It summarizes the current data for calcium as a screening tool, which is strongest in establishing that asymptomatic people undergo increased rates of revascularization after an EBCT test. Widespread clinical use of EBCT is not recommended, pending data to establish its efficacy in the role of risk factor reduction and prevention of cardiovascular disease.