Coronary Artery Disease Screening

Coronary calcium screening worthwhile in asymptomatic patients at risk for CHD

NEW YORK (Reuters Health), Aug 27 – Findings from a large observational study support the use of coronary artery calcium screening with electron-beam computed tomography (ECBT) in asymptomatic patients who are at risk for coronary disease.

Among 10,377 such patients followed for a mean of 5 years, coronary calcium provided “independent incremental information in addition to traditional risk factors in the prediction of all-cause mortality,” researchers report in the September issue of the journal Radiology.

Study subjects, who ranged from age 30 to 85, were considered to be at above-average risk for coronary disease due to a family history of coronary disease (69%), hypercholesterolemia (62%), hypertension (44%), smoking (40%), diabetes (9%), or advanced age.

According to Dr. Paolo Raggi from Tulane University Hospital and Clinic in New Orleans and colleagues, 57% of subjects had coronary calcium scores of 10 or less, while 20%, 14%, 6%, and 3% had scores of 11-100, 101-400, 401-1,000, and > 1,000, respectively.

During follow up, the death rate was 2.4%. In a risk-adjusted model, coronary calcium score emerged as an independent predictor of mortality (p [ 0.001).

The relative risk of death was 1.64, 1.74, 2.54, and 4.03 times greater for calcium scores of 11-100, 101-400, 401-1,000, and > 1,000, respectively, compared with scores of 10 or less.

“Our results show that survival at 5 years worsens substantially as the screening calcium scores increase from levels of 10 or less to those greater than 1,000,” Dr. Raggi and colleagues write. “Therefore, it appears justified to use coronary calcium screening to identify intermediate-risk patients with traditional risk factors for whom aggressive risk-reducing strategies for the treatment of atherosclerotic disease should be indicated,” they conclude.

In a prior study, Dr. Raggi’s team reported that high calcium scores were associated with a significantly increased risk of coronary events in asymptomatic individuals.

Last Updated: 2003-08-27 10:45:26 -0400 (Reuters Health)

Radiology 2003;228:826-833.

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