The Common Vein

Indications

• 95H Normal Calcium Score ? equivocal plaque

Definition

•  preventive tool
• used to identify calcific atheroscleosis

BAckground

• Approximately 50% of all cardiovascular disease (CVD)?related deaths
  • no prior cardiac symptoms or diagnoses,

Aim

• Identify the presence of atherosclerosis in
• patients in whom management may change
  • ie those wh would benefit for conservative preventive management
    • positive family history
    • ACC Risk Calculator
    • categorised
      • low-risk,
      • intermediate-risk, and h
      • igh-risk for future heart attacks.

Indications

• Smoking,
• Obesity,
• hypercholesterolemia
• hypertension,
• diabetes
• sedentary lifestyl
• positive family history of myocardial infarction,
• inflammatory diseases like rheumatoid arthritis, diabetes.

Calcium score should be considered in people between 45-70 years of age.

• Under 40, the zero score?s negative predictive value is not high since there has not been enough time for the lipid-rich-plaques to calcify.

• Above 70,
  • nearly everyone has calcification of the coronary arteries. 
    • positive unless significantly elevated,
      • not necessarily signify high risk. 
    • calcium score of 0
      • very high negative predictive value. 

Contraindications

• Relative
  • very low pretest probability
  • very high  CV risk
    • since they prevention Rx anyway

Advantages

• High sensitivity for atherosclerosis
• low radiation 1mSV
• the more burden the more benefit with conservative therapy
  • statins

Disadvantages

• Radiation

Method

• Patient Prep

• Technique

  • Gated
  • Multi

Results

• Report should include
  • the absolute Agatston score and the
  • age, sex, and race-specific CAC percentile;
  • the number of vessels with CAC;
  • the presence of CAC in the left main coronary artery;
  • specific highlighting of individuals with very high CAC scores of greater than 1000
• Test of plaque burden
• A calcium score of 20 in a
  • 70-year-old person is low but in a 
  • 35-40-year-old is significantly ele
    • should be considered considerably elevated.

Conclusions

• In a patient with negative calcium score – we do not know if there is fibrofatty plaque

• 

• A high coronary calcium score can change someone?s risk from low to high but not the other way. A low or even zero calcium score does not change the status of a high-risk patient to a low-risk. A ?high risk? individual will remain ?high risk? regardless of their calcium score.
• calcium score should always be interpreted in the
  • context of other risk factors
  • never solely.
    • 0 in a low-risk patient is highly reassuring.
    • 0 in high risk patient
      •  smokes
      • high cholesterol or
      • high blood pressure
    • is less predictive.
• Associated diseases with high calcium score
  • cancer

Links and References

• Journal Articles
  • Patel, J et al Assessment of Coronary Artery Calcium Scoring to Guide Statin Therapy Allocation According to Risk-Enhancing FactorsThe Multi-Ethnic Study of Atherosclerosis JAMA Cardiol. 2021;6(10):1161-1170.  Abstract Only
•  Videos
  • Blaha Michael Yale Grand Rounds 2022
  • Medcape MedPage  Peer to Peer Philip Green
• Guidelines
  • 2022