TY - JOUR
T1 - Role of nonenhanced multidetector CT coronary artery calcium testing in asymptomatic and symptomatic individuals
AU - Nasir, Khurram
AU - Clouse, Melvin
PY - 2012/9/1
Y1 - 2012/9/1
N2 - Arteriosclerotic cardiovascular disease is the leading cause of death in the United States, with coronary artery disease (CAD) accounting for half of all cardiovascular disease deaths. Current risk assessment approaches for coronary heart disease, such as the Framingham risk score, substantially misclassify intermediate- to long-term risk for the occurrence of CAD in asymptomatic individuals. A screening modality such as a simple non-contrast-enhanced, or noncontrast, computed tomographic (CT) detection of coronary artery calcium (CAC) improves the ability to accurately predict risk in vulnerable groups and adds information above and beyond global risk assessment as shown by the recent Multi-Ethnic Study of Atherosclerosis. In addition, absence of CAC is associated with a very low risk of future CAD and as a result can be used to identify a group among which further testing and pharmacotherapies can be avoided. The Expert Consensus Document by the American College of Cardiology Foundation and the American Heart Association now recommends screening individuals at intermediate risk but did not find enough evidence to recommend CAC testing and further stratification of those in the low- or high-risk categories for CAD. In addition, emerging guidelines have suggested that absence of CAC can act as a "gatekeeper"for further testing among low- and intermediate-risk patients presenting with chest pain. This review of the current literature outlines the role of CAC testing in both asymptomatic and symptomatic individuals.
AB - Arteriosclerotic cardiovascular disease is the leading cause of death in the United States, with coronary artery disease (CAD) accounting for half of all cardiovascular disease deaths. Current risk assessment approaches for coronary heart disease, such as the Framingham risk score, substantially misclassify intermediate- to long-term risk for the occurrence of CAD in asymptomatic individuals. A screening modality such as a simple non-contrast-enhanced, or noncontrast, computed tomographic (CT) detection of coronary artery calcium (CAC) improves the ability to accurately predict risk in vulnerable groups and adds information above and beyond global risk assessment as shown by the recent Multi-Ethnic Study of Atherosclerosis. In addition, absence of CAC is associated with a very low risk of future CAD and as a result can be used to identify a group among which further testing and pharmacotherapies can be avoided. The Expert Consensus Document by the American College of Cardiology Foundation and the American Heart Association now recommends screening individuals at intermediate risk but did not find enough evidence to recommend CAC testing and further stratification of those in the low- or high-risk categories for CAD. In addition, emerging guidelines have suggested that absence of CAC can act as a "gatekeeper"for further testing among low- and intermediate-risk patients presenting with chest pain. This review of the current literature outlines the role of CAC testing in both asymptomatic and symptomatic individuals.
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U2 - 10.1148/radiol.12110810
DO - 10.1148/radiol.12110810
M3 - Review article
C2 - 22919038
AN - SCOPUS:84865417902
SN - 0033-8419
VL - 264
SP - 637
EP - 649
JO - Radiology
JF - Radiology
IS - 3
ER -