Rumberger JA, Brundage BH, Rader DJ, Kondos G
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 coronarycalcium 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.
Rumberger JA, Brundage BH, Rader DJ, Kondos G. Electron Beam Computed Tomographic Coronary Calcium Scanning: A Review and Guidelines for Use in Asymptomatic Persons. Mayo Clin Proc 1999; 74:243-252