Coronary calcium scoring (CCS) is arguably the best adjustment to awning for coronary avenue disease. The best absorbing allotment of this analysis is the direct-to-consumer announcement that occurs to the public. There are not too abounding medical tests (especially those with radiation exposure) that anyone can acquirement at an affordable bulk after a doctor’s order. Vascular screening is addition example. Is it actually adapted for hospitals and offices to acquiesce anyone to airing in and acquire a coronary calcium account performed? Hmmm … acceptable question.
First, let me briefly alarm what coronary calcium scoring is for those not accustomed with the test. This analysis uses computed tomography (CT) after IV adverse to browse the heart. It is quick and painless, actually demography alone minutes. Calcium is actually ablaze on a CT browse and calmly visualized. Computer programs can calmly analyze and quantify how abundant calcium is detected on CT in any alone application what is alleged the Agatston score. The college the bulk of calcium detected, the college the accident for a coronary stenosis, astute coronary affection and cardiac death.
What abstracts abutment the use of calcium scoring to awning for coronary disease? There is a aberration amid a analysis accepting predictive amount of cardiovascular ache and one that has actually been apparent to advance analytic outcomes. Predicting accident is nice, but we actually should focus on things that abate anguish and mortality. The predictive abstracts are able that array of 0 acquire a actual low accident (< 1%) of a cardiovascular accident aural 3 to 5 years. On the added side, a account > 100 in one abstraction showed a 7-fold added accident for cardiovascular contest compared with those with no apparent coronary calcium. To this date, there are no abstracts to appearance that the act of screening for coronary calcium reduces cardiac contest or mortality. However, it would accomplish accepted faculty that an asymptomatic 55-year-old with an Agatston coronary calcium account of 1,000 who was not demography aspirin or an HMG-CoA reductase inhibitor would acquire a bigger aftereffect if they started one, right? There is no absolute affirmation to abutment this, yet.
In my opinion, as continued as a able screening action is in abode to ensure that those with a low pre-test anticipation and those with a aerial pre-test anticipation do not afield acquire coronary calcium scoring performed, again I anticipate it is actually a acceptable account to offer. I acquire alone started coronary calcium scoring programs at added than one facility. While the aggregate of patients accepting the analysis area I convenance is low (perhaps one per day), we do acquire a absolute check to ensure that alone intermediate-risk individuals acquire the test. No doctor’s adjustment is all-important and the amount is an affordable $99. Each accommodating receives a buzz alarm from a cardiologist to altercate the after-effects of their browse and acknowledgment questions. We crave the accommodating account a primary affliction physician so the after-effects acquire a abode to go and do not get absent in space.
Note that a coronary calcium account IS NOT a analysis to see if a patient’s affection are heart-related. To appraise chest affliction or added abeyant anginal symptoms, accent testing is the adopted method. A person’s calcium account could be actually aerial after any adverse coronary binding (and anchor versa). It is important to accumulate this analysis as a accident appraisal only. Patients may acquire a altered acumen if not able-bodied accomplished and ability acquire the browse done to see if their “heartburn” is actually from their heart. This is actually inappropriate and potentially dangerous. Attending at this angel beneath assuming a CT of a coronary barge with all-encompassing calcification, again attending at the correlating invasive coronary angiogram assuming actually no flow-limiting stenosis:
There are abounding belief you may hear, both acceptable and bad, surrounding calcium scoring. The best notable is the ahead advantageous alone (sometimes alike actually athletic) after any affection of angina or affection ache who gets a coronary calcium account performed and has an astronomically aerial score. Hmmm … if the being has no symptoms, do we actually charge to revascularize the coronary binding with stents of surgical bypass? Not necessarily, but that’s a altered topic. Certainly, alike if no coronary action is needed, an aberrant calcium account can be actually an eye-opener. Aspirin and HMG-CoA reductase inhibitors may be recommended in abounding cases back the calcium account is aerial for primary blockage of analytic affection disease. Again, bethink that a aerial calcium account does not necessarily beggarly that a coronary binding is present, although it is added likely.
How about the adverse scenario? A being who has a absolute calcium account of 0. Could that alone still ache a affection attack? Absolutely! I consistently acquaint patients that back their account is 0 it is not a chargeless canyon to affair and be unhealthy. Coronary calcium scoring alone detects calcium, as the name implies. Could there be a bendable applique fabricated predominantly of cholesterol? Sure. Take a attending at the angel beneath assuming a astringent coronary binding after any calcification on CT scanning and the associated invasive coronary angiography image:
We additionally apperceive that the plaques with little or no calcium tend to acquire thin, coarse caps and are added decumbent to ulceration or rupture, causing an astute coronary syndrome. To date there is no acceptable clinically applicative way to accomplish coronary applique assuming that will adumbrate which applique is affected to rupture.
So, to get a coronary calcium account or not? Is it account the 0.9 mSv to 2.4 mSv of radiation exposure? If you are a middle-aged being with no antecedent affection ache analysis or accident agnate (diabetes or borderline arterial disease), no abeyant anginal symptoms, and some accident factors for affection ache such as hypertension, tobacco use, dyslipidemia or a ancestors history of ischemic affection disease, again this analysis is for you … as continued as you acquire and acquire the accident of radiation exposure, which is low but present. Conceivably every 3 years the analysis can be again to appraise for any change, about no added frequently than that. It is apparently one of the best means the adapted being could absorb $99, in my opinion!
– by Steven Lome, DO, RVT
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