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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
04:40

Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans

Published on: August 28, 2018

An evidence-based guide for coronary calcium scoring in asymptomatic patients without coronary heart disease

Nishant R Shah1, Stephanie A Coulter

  • 1Center for Women's Heart & Vascular Health, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.

Texas Heart Institute Journal
|June 29, 2012
PubMed

Insights

Coronary artery calcium (CAC) screening identifies coronary heart disease (CHD) but doesn't predict blockages. A CAC score of zero is reassuring, while higher scores indicate increased risk, guiding patient management.

Area of Science:

  • Cardiovascular Imaging
  • Preventive Cardiology
  • Radiology

Background:

  • Increasing awareness and clinical application of coronary artery calcium (CAC) screening necessitate physician understanding.
  • CAC presence signifies underlying coronary heart disease (CHD) but does not indicate luminal obstruction.

Purpose of the Study:

  • To outline essential knowledge for physicians regarding CAC screening.
  • To define appropriate screening criteria, interpret CAC scores, and understand associated risks.

Main Methods:

  • Utilizes non-contrast, prospectively ECG-gated electron beam computed tomography (EBCT) and multi-detector computed tomography (MDCT) for CAC screening.
  • Evaluates the predictive value of CAC scores for CHD events.

Main Results:

  • CAC screening is sensitive, reproducible, rapid, and effective.
  • Appropriate for intermediate-risk patients, low-risk patients with a family history of premature CHD, and potentially low-risk women.
  • A CAC score of zero has a high negative predictive value for CHD events.
  • Increasing CAC scores correlate directly with elevated CHD event risk; scores >100 or >75th percentile signify high risk.
  • Risks include minimal excess cancer risk and potential for unnecessary downstream procedures.

Conclusions:

  • CAC screening is a valuable tool for risk stratification in specific patient populations.
  • A zero CAC score strongly suggests a low likelihood of CHD events.
  • Repeat screening for progression/regression is not currently recommended.

Keywords:
Calcinosis/diagnosis/epidemiology/radiographycalcium/analysiscardiac imaging techniques/standardscoronary artery disease/radiographyevidence-based medicinepractice guidelines as topicradiation dosagerisk assessment/economics/methodstomography, spiral computedtomography, x-ray computed

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