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Screening for Coronary Artery Calcium with Computed Tomography: Angiography and Intervention in Patients with Scores Ove

Screening for Coronary Artery Calcium with Computed Tomography: Angiography and Intervention in Patients with Scores Over 400 W. Goodwin, M. Fuseini, J. Norton, J.Mehta, E. Ferris; University of Arkansas for Medical Sciences, Little Rock, AR .

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Screening for Coronary Artery Calcium with Computed Tomography: Angiography and Intervention in Patients with Scores Ove

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  1. Screening for Coronary Artery Calcium with Computed Tomography: Angiography and Intervention in Patients with Scores Over 400 W. Goodwin, M. Fuseini, J. Norton, J.Mehta, E. Ferris; University of Arkansas for Medical Sciences, Little Rock, AR

  2. HEART DISEASE IS THE LEADING CAUSE OF DEATH IN THE INDUSTRIALIZED WORLD

  3. 50% OF PEOPLE WHO DIE FROM HEART DISEASE HAVE AN ACUTE MYOCARDIAL INFARCTION OR SUDDEN DEATH AS THEIR FIRST PRESENTATION

  4. Over 50% of MI’s occur in patients who are low or intermediate risk using traditional risk factors • Up to 30% of diagnostic coronary caths are negative

  5. A QUICK, EASY, ACCURATE, NON-INVASIVE TEST FOR SIGNIFICANT CORONARY ARTERY DISEASE WOULD BE HIGHLY DESIRABLE AS HEART DISEASE HAS BECOME MORE TREATABLE

  6. CORONARY ARTERY CALCIFICATION HAS BEEN SHOWN TO BE A MARKER FOR CORONARY ARTERY ATHEROSCLEROSIS

  7. CALCIFICATION CAN BE SEEN WITH FLUOROSCOPY AND ON CHEST X-RAY • COMPUTED TOMOGRAPHY ALLOWS QUANTIFICATION OF THIS CALCIUM

  8. SCORES ARE BASED ON MEASURED AREA AND PEAK CT NUMBER WITHIN THE BORDERS OF EACH CORONARY ARTERY. • WE USED THE AGATSTON METHOD

  9. PATIENTS WERE SCANNED USING NON-CONTRASTED 2.5 MM SLICES THROUGH THE HEART • EXAM IS PERFORMED DURING A SINGLE BREATH HOLD

  10. THESE STUDIES MUST BE EKG GATED IN ORDER TO DECREASE MOTION ARTIFACT • SCANS ARE OBTAINED AT 80% OF THE R-R INTERVAL

  11. PATIENTS WERE SELF-REFERRED AND ASYMPTOMATIC AT THE TIME OF THE CT SCAN • ALL EXAMS WERE DONE ON THE SAME 4 DETECTOR SCANNER

  12. 3,368 people were screened between 2000 and 2003 • 1793 men • 1575 women • Age : 21-92 (54 ± 9.4 years) • Average follow-up was 16 months(3-30 months)

  13. males

  14. females

  15. total

  16. 19% of patients who reported having diabetes had scores over 400 • 8% of the total population had scores over 400 • p<.0001

  17. 277 people (8%) had scores over 400. • Of these 69 (25%) underwent coronary angiography

  18. 58/69 (84%) had a coronary artery with at least a 50 % stenosis by angiography

  19. 44/69 (64%) had an intervention including: • Angioplasty • Stent placement • And/or coronary artery bypass grafting

  20. In this study group there were 7 confirmed deaths • 6/7 (86%) occurred in the over 400 group

  21. Mortality ≥ 400 = 2.2% • Mortality < 400 = 0.03% • p<.0001

  22. Mortality in the group who had scores over 400 and who had an intervention was 2/44 or 4.5% Mortality in the group who had scores over 400 and who did not have an intervention was 4/233 or 1.7% p=.24 (not significant) We will continue to follow these patients to see if a trend develops over time

  23. % of subjects who had measurable calcium in specific arteries

  24. Calcium score and angiogram results were evaluated for the left main, LAD, circumflex, and right coronary arteries • An angiogram was considered positive if there was a 50% or greater stenosis

  25. T-tests were performed to evaluate for an association between the calcium score in a specific artery and the angiogram results for that artery • None of the four tests showed a significant association

  26. CT CORONARY CALCIUM SCORING DOES NOT: • PREDICT WHICH SPECIFIC CORONARY ARTERIES ARE STENOTIC • PROVIDE ENOUGH INFORMATION TO BE CERTAIN WHO DOES AND WHO DOES NOT NEED INTERVENTION

  27. A HIGH CT CORONARY CALCIUM SCORE IS ASSOCIATED WITH: • DIABETES • INCREASING AGE • CORONARY ATHROSCLEROSIS • SIGNIFICANT LUMINAL NARROWING • INCREASED MORTALITY • INCREASED CARDIAC DEATH

  28. CALCIFICATION OF THE CORONARY ARTERIES WILL CONTINUE TO BE RELEVANT BECAUSE OF ITS RELATIONSHIP TO HEART DISEASE AND DUE TO ITS EFFECT ON CT ANGIOGRAPHY OF THE CORONARY ARTERIES

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