Coronary artery pdf

Log in with Facebook Log in with Google. Remember me on this computer. Enter the email address you signed up with and we'll email you a reset link. Need an account? Click here to sign up. Download Free PDF. Coronary artery calcium scoring: Its practicality and clinical utility in primary care Cleveland Clinic journal of medicine, Paul Schoenhagen. A short summary of this paper. Coronary artery calcium scoring: Its practicality and clinical utility in primary care.

However, if the test is not ate, and many coronary events occur in people used in the appropriate clinical setting, misinterpretation considered to be at low or intermediate risk. Primary care KEY POINTS providers are either using it or are seeing it used by consulting physicians, and its rela- Coronary artery calcium testing is useful in diagnosing tively low cost and ease of performance have subclinical coronary artery disease and in predicting the contributed to its widespread use.

However, risk of future cardiovascular events and death. Inflammatory cells such as macrophages and foam cells are then recruited to the areas of deposition where they cause apoptosis, creating a necrotic core with doi Pathogenic mechanism of atherosclerotic lesions and its relationship to the coronary artery calcium CAC score.

A type 2 lesion contains an accumulation of foam cells. The type 3 lesion contains collections of extracellular lipid droplets. Eventually, these extracellular lipid pools form a lipid core, and a type 4 lesion is created. Type 6 is a complicated lesion that can include thrombus from plaque rupture.

First-generation CT scanners used for calcium Sangiorgi et al7 performed a histologic scoring in the s were electron-beam sys- analysis of coronary artery segments. The tems in which a stationary x-ray tube gener- amount of calcium correlated well with the ated an oscillating electron beam, which was area of plaque: reflected around the patient table.

TABLE 1 These systems have been replaced by mul- tidetector scanners, in which the x-ray tube Categories of coronary artery and multiple rows of detectors are combined calcium scores in a gantry that rotates at high speed around Score Category the patient.

Coronary calcium is measured by non- 0 No atherosclerosis contrast CT of the heart. Thus, there is no 1—99 Mild disease risk of contrast-induced nephropathy or al- lergic reactions. Electrocardiographic gating is used to reduce motion artifact.

Blaha et al20 concluded that a score of 0 Calcification is defined as a hyperattenuating would indicate that the patient had a low risk lesion above the threshold of Hounsfield of cardiovascular disease. A test with these units with an area of 3 or more pixels 1 mm2. Other scores, which tomatic patients with subsequent follow-up. A screenshot from a standard calcium scoring program. The table in the left lower panel lists the results of the calcium score.

The graph in the right lower panel shows the Atherosclerosis results of the individual patient relative to an age- and sex-matched patient population eg, begins in the the MESA trial. This patient has a score of A limitation are deposited those with higher scores had a higher risk of of this study was that the patients and physi- atherosclerotic cardiovascular disease events.

This study was er population ages 32— In Because risk scores are strongly influ- multivariable model controlling for age, sex, enced by age,29 they are least reliable in young ethnicity, and cardiac risk factors model chi- adults. However, most of Akosah et al31 reviewed the records of the patients were already known to have car- young adults women age 55 or younger, men diac risk factors, making the study findings less age 65 or younger who presented with their generalizable to the general population.

Interestingly, those results in low specificity in elderly adults. Us- with no risk factors but a calcium score great- ing risk scores, elderly adults are systematically er than had a higher mortality rate than stratified in higher risk categories, expanding those with no coronary calcium but more than the indication for statin therapy to almost all 3 risk factors Moreover, our atherosclerosis symptoms but with elevated coronary calcium scores had higher all-cause mortality rates at knowledge about genetic and epigenetic fac- 15 years than those with a score of 0.

The dif- tors associated with the development of ath- ference remained significant after Cox regres- erosclerosis is still in its infancy, with current sion was performed, adjusting for traditional guidelines not supporting genetic testing as risk factors. Therefore, death in the subsequent 10 years. The score was vali- implications regarding whether to start thera- dated externally with 2 separate longitudinal pies such as statins and aspirin. Thus, this may serve as another tool For considering statin therapy to help providers further risk-stratify patients.

The number needed to treat to prevent an Cost-effectiveness depends not only on pa- atherosclerotic cardiovascular event in the tient selection but also on the cost of therapy.

In the be beneficial. This is especially be at a lower risk. Those in the United States are believed to be un- with a calcium score higher than had a necessary and may lead to additional testing number needed to treat of in the group to investigate incidental findings. The estimated number needed to tion exposure, healthcare costs, and increased harm for a major bleeding event was Therefore, the presence Some of these concerns have been ad- or absence of symptoms should guide the cli- dressed.

Modern scanners can acquire images nician on whether to pursue stress testing for in only a few seconds, entailing lower radia- invasive coronary angiography based on the tion doses than in the past. As discussed above, a score higher than preventive interventions guided by calcium could be a rationale for starting aspirin scores on hard event outcomes.

It can be ar- therapy, and a score higher than 0 for statin gued that there have been plenty of observa- therapy. The current guidelines also mention tional studies that have shown the benefit of that the coronary calcium score is comparable coronary calcium scoring when judiciously to other predictors such as the C-reactive pro- done in the appropriate population.

The feasibility and cost of a large The sensitivity consensus recently have added more specifics randomized controlled trial to assess outcomes of coronary in terms of using this test for asymptomatic pa- after coronary artery calcium measurement tients at intermediate risk year risk of ath- calcium scoring must also be considered.

This could have Given the negative predictive value of the been determined without an invasive test in coronary calcium score, our approach has been an otherwise asymptomatic patient. This is preceded by a lengthy patient- physician discussion about the risks and ben- Example 3 efits of the test. A dis- is unremarkable, and cardiac enzyme tests are cussion can then take place on potentially negative. Would coronary calcium scoring be starting pharmacologic therapy, intensive life- reasonable?

Therefore, she has a be shown to the patient in the office to point low pretest probability of obstructive coronary out coronary calcifications. Seeing the lesions artery disease. Moreover, calcium scoring may may serve an as additional motivating factor not be helpful because at her young age there as patients embark on primary preventive ef- has not been enough time for calcification forts.

Thus, she would be exposed to radiation consider appropriate and inappropriate use of unnecessarily at a young age. What to do with an elevated calcium score? Despite an Force guidelines. Patients may also get the test cardiovascular extensive conversation about lifestyle modifica- done on their own and then present to a pro- disease events tions and pharmacologic therapy, he is reluctant vider with an elevated score.

He is otherwise asymp- It is important to consider the entire clini- and death tomatic. Would calcium scoring be reasonable? If a patient presents with an elevated onary artery calcium scoring in an otherwise calcium score but has no symptoms and falls in calcium score asymptomatic man to help reclassify his risk the intermediate-risk group, there is evidence for a coronary vascular event.

The objective to suggest that he or she should be started on data provided by the test could motivate the statin or aspirin therapy or both. However, if A year-old man who has a family history of the patient is symptomatic, then further car- coronary artery disease, is an active smoker, and has diabetes mellitus presents to the clinic with 2 diac evaluation would be recommended.

Measuring coronary artery calcium has been This patient is symptomatic and is at high found to be valuable in detecting coronary ar- risk of coronary artery disease. The test is relatively easy lines, since he has diabetes.

It serves as a more documents are more specific in recommend- personalized measure of disease and can help ing the test in asymptomatic patients in the facilitate patient-physician discussions about intermediate-risk group. J Cardiovasc Comput Tomogr ; 3 6 — Hansson GK. Low- vs. Plaque is made up of cholesterol deposits. Plaque buildup causes the inside of the arteries to narrow over time.

This process is called atherosclerosis. It is sometimes called coronary heart disease or ischemic heart disease. For some people, the first sign of CAD is a heart attack. You and your health care team may be able to help reduce your risk for CAD. CAD is caused by plaque buildup in the walls of the arteries that supply blood to the heart called coronary arteries and other parts of the body.

Plaque is made up of deposits of cholesterol and other substances in the artery. Plaque buildup causes the inside of the arteries to narrow over time, which can partially or totally block the blood flow.

Angina , or chest pain and discomfort, is the most common symptom of CAD. Angina can happen when too much plaque builds up inside arteries, causing them to narrow. Narrowed arteries can cause chest pain because they can block blood flow to your heart muscle and the rest of your body. For many people, the first clue that they have CAD is a heart attack. Symptoms of heart attack include. Over time, CAD can weaken the heart muscle. Learn the facts about heart disease , including coronary artery disease, the most common type of heart disease.

Overweight, physical inactivity, unhealthy eating, and smoking tobacco are risk factors for CAD. A family history of heart disease also increases your risk for CAD, especially a family history of having heart disease at an early age 50 or younger.

To find out your risk for CAD, your health care team may measure your blood pressure, blood cholesterol, and blood sugar levels. Cardiac rehabilitation rehab is an important program for anyone recovering from a heart attack, heart failure, or other heart problem that required surgery or medical care. In these people, cardiac rehab can help improve quality of life and can help prevent another cardiac event.

Cardiac rehab is a supervised program that includes. A team of people may help you through cardiac rehab, including your health care team, exercise and nutrition specialists, physical therapists, and counselors or mental health professionals. If you have CAD, your health care team may suggest the following steps to help lower your risk for heart attack or worsening heart disease:. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Heart Disease.