Comparison of electron beam computed tomography scanning and conventional risk factor assessment for the prediction of angiographic coronary artery disease

Guerci, Alan D.; Spadaro, Louise A.; Goodman, Ken; Lledo-Perez, Alfonso; Newstein, David; Lerner, Gail; Arad, Yadon

doi:10.1016/s0735-1097(98)00299-x

Cited by 157 publications

(75 citation statements)

References 20 publications

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“…This result is consistent with previous studies demonstrating that the angiographic extent and severity of CAD are directly related to CACS severity 11,12 and that angiographic stenosis severity best predicts an abnormal SPECT. 2,16 Our findings emphasize that EBCT is more sensitive than either ETT or SPECT for detecting subclinical CAD in which aggressive risk factor modification is war- …”

Section: Discussionsupporting

confidence: 92%

“…It is unlikely, however, that studying a larger population with CACS Յ100 would have altered our results because these individuals generally have insignificant CAD by angiography. 11,12,14 Another issue is whether our results vary with subject age. We observed similar correlations between SPECT and EBCT when individuals were dichotomized at 50 years of age; analysis by decade of life would require a larger sample size.…”

Section: Study Limitationsmentioning

confidence: 88%

“…[7][8][9] Electron beam computed tomography (EBCT) is a new noninvasive technique that can detect coronary atherosclerosis even at its earliest stages on the basis of the presence and severity of coronary artery calcification. 10 Although calcification severity predicts the presence of significant anatomic CAD, 11,12 there is little information as to whether the coronary artery calcium score (CACS) can identify asymptomatic individuals at high risk for having myocardial ischemia among a larger, asymptomatic, heterogeneous population with cardiac risk factors. 12 This is clinically important because the presence and extent of left ventricular ischemia predict outcome beyond that provided by coronary angiographic findings alone.…”

mentioning

confidence: 99%

“…10 Although calcification severity predicts the presence of significant anatomic CAD, 11,12 there is little information as to whether the coronary artery calcium score (CACS) can identify asymptomatic individuals at high risk for having myocardial ischemia among a larger, asymptomatic, heterogeneous population with cardiac risk factors. 12 This is clinically important because the presence and extent of left ventricular ischemia predict outcome beyond that provided by coronary angiographic findings alone. 4,5,13 Accordingly, the purpose of this study was to determine whether EBCT could identify subjects with scintigraphic ischemia on the basis of CACS severity and thereby define its role as a primary screening technique for identifying subjects with a broad spectrum of CAD.…”

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confidence: 99%

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Severity of Coronary Artery Calcification by Electron Beam Computed Tomography Predicts Silent Myocardial Ischemia

et al. 2000

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Background-Detection of subclinical coronary artery disease (CAD) before the development of life-threatening cardiac complications has great potential clinical relevance. Electron beam computed tomography (EBCT) is currently the only noninvasive test that can detect CAD in all stages of its development and thus has the potential to be an excellent screening technique for identifying asymptomatic subjects with underlying myocardial ischemia. Methods and Results-Over 2.5 years, we prospectively studied 3895 generally asymptomatic subjects with EBCT, 411 of whom had stress myocardial perfusion tomography (SPECT) within a close (median, 17 days) time period. SPECT and exercise treadmill results were compared with the coronary artery calcium score (CACS) as assessed by EBCT. The total CACS identified a population at high risk for having myocardial ischemia by SPECT although only a minority of subjects (22%) with an abnormal EBCT had an abnormal SPECT. No subject with CACS Ͻ10 had an abnormal SPECT compared with 2.6% of those with scores from 11 to 100, 11.3% of those with scores from 101 to 399, and 46% of those with scores Ն400 (PϽ0.0001). CACS predicted an abnormal SPECT regardless of subject age or sex. Conclusions-CACS

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Section: Discussionsupporting

confidence: 92%

Section: Study Limitationsmentioning

confidence: 88%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Severity of Coronary Artery Calcification by Electron Beam Computed Tomography Predicts Silent Myocardial Ischemia

et al. 2000

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“…10 The measurement of coronary calcification by EBCT is a more direct approach for noninvasively measuring the extent of coronary artery disease. 11 Previous studies have shown that coronary artery calcification is related to the extent of coronary atherosclerosis and is greater in patients with myocardial infarction. 12,13 Coronary artery calcification increases with age in both sexes and is substantially greater in men than in women, especially in the younger age groups.…”

mentioning

confidence: 99%

Coronary and Aortic Calcification Among Women 8 Years After Menopause and Their Premenopausal Risk Factors

Kuller

Matthews

Sutton-Tyrrell

et al. 1999

ATVB

132

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Abstract-In the Healthy Women Study, the relationship between cardiovascular risk factors measured premenopausally at age 48, use of hormone therapy, and coronary and aortic calcification at age 58 were evaluated among 169 women. Approximately 63% of women had no coronary calcification, but only 29% had no aortic calcification. Coronary calcification and aortic calcification were positively correlated with each other. There was a very strong association between low density lipoprotein cholesterol (LDL-C) level and coronary calcification. Among women with premenopausal levels of LDL-C Ͻ100 mg/dL, only 9% had a coronary calcium score Ն101 compared with 30% of women with an LDL-C Ͼ160 mg/dL. Only 5% of women with a high density lipoprotein cholesterol (HDL-C) level Ͼ60 mg/dL had high coronary scores. The level of HDL 2 -C was especially strongly inversely related to coronary calcium scores. Cigarette smoking was a very important determinant of both high aortic and high coronary calcium scores. Other risk factors associated with greater coronary calcium were higher systolic blood pressure, triglycerides levels, and blood glucose. Use of hormone replacement therapy was associated with less coronary calcium (NS). For both hormone replacement therapy users and nonusers, the levels of LDL-C and HDL-C measured premenopausally were predictors of coronary and aortic calcium scores. Thus, risk factors evaluated premenopausally are powerful predictors of coronary and aortic calcification, a marker of atherosclerosis, measured 8 years after menopause, 11 years later in these women. Key Words: coronary artery disease Ⅲ coronary calcification Ⅲ lipids Ⅲ smoking Ⅲ hormone replacement therapy T he development of new techniques to measure the extent of subclinical cardiovascular disease, such as carotid duplex scanning and electron beam CT (EBCT), has provided important new approaches to study the relationship of risk factors and cardiovascular disease. In this article, we report the relationship between cardiovascular risk factors measured premenopausally and coronary and aortic calcification for 168 women, as measured by EBCT, in the Healthy Women Study (HWS) at the eighth postmenopausal visit. 1,2 In previous reports from the HWS, we evaluated the determinants of changes in cardiovascular risk factors from the premenopause, perimenopause, and postmenopause. 3 There was an increase in LDL cholesterol (LDL-C), little change in total HDL-C, a substantial decline in HDL 2 -C, and an increase in HDL 3 -C. The women gained Ϸ1 pound per year from the perimenopause through the postmenopausal years. Weight gain was associated with a substantial increase in LDL-C, triglycerides, and systolic blood pressure and a decrease in HDL-C levels. 4 In this article, we evaluated 2 hypotheses. First, we predicted that the cardiovascular risk factors that predict clinical cardiovascular disease in elderly women would also predict coronary and aortic calcification in middle-aged women. The extensive risk factor assessment was completed when the women...

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Cholesterol Lowering in the Elderly Population

Grundy

Cleeman

Rifkind³

et al. 1999

Arch Intern Med

100

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Comparison of electron beam computed tomography scanning and conventional risk factor assessment for the prediction of angiographic coronary artery disease

Abstract: Electron beam CT scanning offers improved discrimination over conventional risk factors in the identification of persons with any angiographic coronary disease or angiographic obstructive coronary disease.

Cited by 157 publications

References 20 publications

Severity of Coronary Artery Calcification by Electron Beam Computed Tomography Predicts Silent Myocardial Ischemia

Severity of Coronary Artery Calcification by Electron Beam Computed Tomography Predicts Silent Myocardial Ischemia

Coronary and Aortic Calcification Among Women 8 Years After Menopause and Their Premenopausal Risk Factors

Cholesterol Lowering in the Elderly Population

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