Coronary Artery Screening by Electron Beam Computed Tomography

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Abstract
There are two things: science and opinion; the first leads to knowledge, the second to ignorance. Hippocrates There has been a dramatic increase in the use of electron beam computed tomography to screen for coronary calcium phosphate deposits. This radiographic procedure, available at increasingly numerous centers in the United States and abroad, can detect small amounts of these deposits. The test costs about $400 (technical fee, including professional interpretation), takes 15 minutes to perform, involves little radiation (similar to that of a barium enema or chest radiograph series), and is noninvasive, not requiring injections or drugs to perform the procedure and obtain results. Advocates of universal coronary calcium screening state that since coronary calcium signifies atherosclerosis, a potentially deadly disease, its detection is important, and a positive screen is reason for aggressive management of risk factors or even further evaluation with exercise testing or angiography. They argue that asymptomatic persons whose coronary status is unknown would benefit from the test, since those with positive scans can be treated more aggressively than those with negative scans and thereby be prevented from suffering myocardial infarctions or cardiac death. Others are not as convinced regarding the value of this new procedure. A recent science advisory published by the American Heart Association1 concluded that the “clinical use of ultrafast computed tomographic imaging to screen patients for coronary artery disease is not justified at this time.” Major reasons given were (1) the lack of a precise correlation between the degree of atherosclerosis and coronary calcium and (2) the unknown prognostic significance of calcification detected by this technology. We summarize in this review the strength of the evidence linking coronary calcium to atherosclerosis and coronary events. We then propose a paradigm on which the future development of this technique can be modeled. On the basis …

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