Calcium of the coronary artery indicates the imminent risk of a heart attack in patients.

Every year, about six million people go to an emergency department with chest pain, but not all have a heart attack – and many do not even run a very low risk.

A new study presented at the Scientific Sessions of the American College Cardiology of the Intermountain Healthcare Heart Institute in Salt Lake City shows that identifying the presence or absence of calcium in the coronary arteries ( CAC) in the arteries of a patient can help determine the risk that it represents for the future.

"With these results, we see more clearly that the presence of calcium in the coronary arteries can help us predict who is most likely to have a cardiac event, not only later in life, but also when the symptoms are present in the near future and I hope to be able to medically intervene in time to stop it, "said Viet T. Le, PA-C, principal investigator and researcher at the Intermountain Healthcare Heart Salt Lake City Institute.

The results of the study were presented at the scientific sessions of the American College of Cardiology in Atlanta on March 16, 2019.

For this study, researchers identified 5,547 patients with no history of coronary heart disease who came to the Intermountain Medical Center with chest pain between April 2013 and June 2016.

These patients had undergone PET / CT examinations to look for ischemia, a disruption of normal blood flow in the heart arteries to the muscle tissue of the heart. This badysis also looks for the presence of CAC, calcium deposits on the walls of the cardiac arteries, indicating atherosclerosis, or plaque, characteristic of heart disease. The researchers then examined patients' medical results for the next four years.

The researchers found that patients who had PCA levels were more likely to develop a cardiac event within 90 days, compared to patients with PET / CT who did not have a PCA. The researchers also found that patients with CAC were also more likely to have high-grade obstructive coronary artery disease, revascularization surgery, and / or other major adverse cardiac events than patients with no calcium in the coronary arteries.

The results can be used in two different ways, Le said.

First, CAC testing can help emergency departments quickly identify patients with chest pain, but are not in acute distress because they may experience another cardiac event from those who may have symptoms other than those related to the heart and they should follow their primary care. doctor to identify the true source of chest pain, which can be as simple as a contracted muscle. These CAC scans are non-invasive, use as much radiation as a mammogram and are relatively inexpensive, particularly compared to PET / CT stress tests, Le said.

Secondly, CACs are not easily identifiable visually at low or moderate levels in the arteries without a formal badysis. Verifying that patients are not experiencing a cardiac event but have suspicious symptoms when they come to the emergency department can help physicians identify people at risk for future events. This allows rapid initiation of lifestyle changes that reduce risk for people with CACs to prevent future events.

"We can have this discussion about improving their lifestyle a little earlier this way because they may not be victims of a high-pitched event, but they're looking at the barrel, let's see so if we can move it further, "said Le.

Future studies are needed to demonstrate whether a CAC first strategy in these symptomatic patients will better identify those who should undergo further stress tests, improve patient education and early implementation. risk reduction strategies.