Coronary artery disease is the No. 1 cause of death in the developed world. Effective
means of treatment such as drug therapy to lower cholesterol levels are available,
but clinical application to patients at highest risk remains imprecise. Electron beam
computed tomography (EBCT) has been suggested as a means to diagnose subclinical coronary
disease and facilitate risk stratification, but no current interpretive consensus
exists in clinical practice. We critically reviewed current, pertinent literature
regarding EBCT coronary calcium scanning from a clinical perspective and, in particular,
studies that evaluated it as a measure of atherosclerotic coronary disease. Additionally,
we reviewed studies that quantified the EBCT “calcium score” in relationship to coronary
heart disease events. The available data suggest that the EBCT calcium score can help
identify persons at higher than anticipated risk of future coronary events: the greater
the EBCT coronary calcium score, the greater the extent of atherosclerotic plaque
disease. Based on the literature review, we offer EBCT interpretation guidelines as
they relate to drug therapy and risk reduction in asymptomatic persons with borderline
cholesterol levels. Considerable evidence shows that coronary calcium is specific
for atherosclerotic plaque and that it can be sensitively detected and accurately
quantified by using EBCT. The coronary calcium score can help guide initiation of
clinical prevention programs as part of a risk stratification and management scheme
aimed at improving outcomes in patients determined to be at highest risk of coronary
disease for their respective age and gender.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Mayo Clinic ProceedingsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- From what will we die in 2020? [editorial].Lancet. 1997; 349: 1263
- Coronary plaque disruption.Circulation. 1995; 92: 657-671
- Apolipoproteins and ischaemic heart disease: implications for screening.Lancet. 1994; 343: 75-79
- Identifying adults at increased risk of coronary disease: how well do the current cholesterol guidelines work?.JAMA. 1995; 274: 801-806
- Calcification of the coronary arteries.AJR Am J Roentgenol. 1959; 81: 772-777
- Significance of calcification of the coronary arteries.Am J Cardiol. 1970; 26: 241-247
- Incidence and significance of coronary artery calcification.Br Heart J. 1974; 36: 499-506
- Coronary calcification in the diagnosis of coronary artery disease.Am J Cardiol. 1979; 44: 141-147
- Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications; a statement for health professionals from the American Heart Association.Circulation. 1996; 94: 1175-1192
- Coronary artery disease: prediction with in vitro electron beam CT.Radiology. 1994; 192: 625-630
- Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area: a histopathologic correlative study.Circulation. 1995; 92: 2157-2162
- Comparison of electron beam computed tomography with intracoronary ultrasound and coronary angiography for detection of coronary atherosclerosis.J Am Coll Cardiol. 1997; 30: 57-64
- Comparison of electron-beam computed tomography and intracoronary ultrasound in detecting calcified and noncalcified plaques in patients with acute coronary syndromes and no or minimal to moderate angiographic coronary artery disease.Am J Cardiol. 1998; 81: 141-146
- Quantification of coronary artery calcium using uitra-fast computed tomography.J Am Coll Cardiol. 1990; 15: 827-832
- Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary angiography.J Am Coll Cardiol. 1996; 27: 285-290
- Predictive value of electron beam computed tomography of the coronary arteries: 19-month follow-up of 1173 asymptomatic subjects.Circulation. 1996; 93: 1951-1953
- Electron beam computed tomographic coronary calcium as a predictor of coronary events: comparison of two protocols.Circulation. 1997; 96: 1122-1129
- Electron beam CT coronary calcium predicts future coronary events [abstract).Circulation. 1996; 94: 1-360
- Electron beam computed tomography and coronary artery disease: scanning for coronary artery calcification.Mayo Clin Proc. 1996; 71: 369-377
- Bone morpriogenetic protein expression in human atherosclerotic lesions.J Clin Invest. 1993; 91: 1800-1809
- Osteopontin mRNA is expressed by smooth muscle-derived foam cells in human atherosclerotic lesions of the aorta.J Clin Invest. 1993; 92: 2814-2820
- Diffuse calcification in human coronary arteries: association of osteopontin with atherosclerosis.J Clin Invest. 1994; 94: 1597-1604
- Expression of osteopontin messenger RNA by macrophages in atherosclerotic plaques: a possible association with calcification.Am J Pathol. 1993; 143: 1003-1008
- Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease?.Circulation. 1988; 78: 1157-1166
- Coronary plaque erosion without rupture into a lipid core: a frequent cause of coronary thrombosis in sudden coronary death.Circulation. 1996; 93: 1354-1363
- Atherosclerosis: basic mechanisms: oxidation, inflammation, and genetics.Circulation. 1995; 91: 2488-2496
- Noninvasive definition of anatomic coronary artery disease by ultrafast computed tomographic scanning: a quantitative pathologic comparison study.J Am Coll Cardiol. 1992; 20: 1118-1126
- Relation of coronary calcium determined by electron beam computed tomography and lumen narrowing determined by autopsy.Am J Cardiol. 1994; 73: 1169-1173
- Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology.J Am Coll Cardiol. 1998; 31: 126-133
- Coronary artery calcification delected with ultrafast CT as an indication of coronary artery disease.Radiology. 1992; 185: 435-439
- Coronary calcium, as determined by electron beam computed tomography, and coronary disease on arteriogram: effect of patient's sex on diagnosis.Circulation. 1995; 91: 1363-1367
- Fast computed tomography detection of coronary calcification in the diagnosis of coronary artery disease: comparison with angiography in patients <50 years old.Circulation. 1994; 89: 285-290
- Coronary artery calcium in acute coronary syndromes: a comparative study of electron-beam computed tomography, coronary angiography, and intracoronary ultrasound in survivors of acute myo-cardial infarction and unstable angina.Circulation. 1997; 96: 1461-1469
- Ultrafast computed tomography as a diagnostic modality in the detection of coronary artery disease: a multicenter study.Circulation. 1996; 93: 898-904
- Quantification of coronary artery calcium by electron beam computed tomography for determination of severity of angiographic coronary artery disease in younger patients.J Am Coll Cardiol. 1995; 25: 626-632
- Electron beam computed tomographic coronary calcium score cutpoints and severity of associated angiographic lumen stenosis.J Am Coll Cardiol. 1997; 29: 1542-1548
- Relation of coronary calcium score by electron beam computed tomography to arteriographic findings in asymptomatic and symptomatic adults.Am J Cardiol. 1997; 79: 128-133
- Outcome ≥10 years after successful percutaneous trsnsluminal coronary angioplasty.Am J Cardiol. 1997; 79: 1005-1011
- The diagnostic and prognostic significance of coronary artery calcification: a report of 800 cases.Radiology. 1980; 137: 609-616
- Prognostic significance of cardiac cinefluoroscopy for coronary calcific deposits in asymptomatic high risk subjects.J Am Coll Cardiol. 1994; 24: 354-358
- Progression to isehemic heart disease in subjects with coronary calcification as evaluated by computed tomography.J Cardiol. 1990; 20: 249-258
- 3.6 Years follow-up of 1136 asymptomatic adults undergoing electron beam CT (EBCT) of the coronary arteries [abstract].J Am Coil Cardiol. 1998; 31: 210A
- Elevated plasma lipoprotein(a) and coronary heart disease in men aged 55 years and younger: a prospective study.JAMA. 1996; 276: 544-548
- Differences in prevalence and extent of coronary artery calcium detected by ultrafast computed tomography in asymptomatic men and women.Am J Cardiol. 1993; 72: 247-254
- Cost-effective strategies in cardiology.in: Braunwald E Heart Disease: A Textbook oi Cardiovascular Medicine. 4th ed. Saunders, Philadelphia1992: 1694-1707
- Evaluating coronary heart disease risk: tiles in the mosaic [published erratum appears in JAMA 1997:278:636].JAMA. 1997; 277: 1387-1390
- Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S).Lancel. 1994; 344: 1383-1389
- Cholesterol and Recurrent Events Trial Investigators). The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels.N Engl J Med. 1996; 335: 1001-1009
- Prevention of coronary heart disease with pravastatin in men with hyper-cholesterolemia.N Engl J Med. 1995; 333: 1301-1307
- AFCAPS/TexCAPS Research Group). Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS.JAMA. 1998; 279: 1615-1622
- Detection of coronary artery calcium to differentiate patients with early coronary atherosclerosis from luminally normal arteries.Am J Cardiol. 1996; 78: 1281-1284
- Summajy of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II).JAMA. 1993; 269: 3015-3023
- The severity of coronary artery calcification by ultrafast computed tomography predicts patients with stress-induced myocardial ischemia [abstract].J Am Coll Cardiol. 1997; 29: 393A
Article info
Identification
Copyright
© 1999 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- CORRECTIONSMayo Clinic ProceedingsVol. 74Issue 5
- Preview• In the article entitled “Electron Beam Computed Tomographic Coronary Calcium Scanning: A Review and Guidelines for Use in Asymptomatic Persons,” which was published in the March 1999 issue of Mayo Clinic Proceedings (Mayo Clin Proc 1999;74:243-252), on page 250 in the footnote section of Table 3, the expansion of “ASA” should be “acetylsalicylic acid.”
- Full-Text
- Preview
