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A new study presented at the American Heart Association's scientific conference revealed that a patient's coronary calcium test is a better predictor of coronary artery blockade at risk for heart attack and need of revascularization compared to the standard risk assessment equations used today in medical practice. .
"With coronary calcium, we are looking at a marker indicating the actual presence of an anatomic disease – we are not only looking for disease probabilities based on a patient's standard risk factors," said Jeffrey L Anderson, cardiologist and cardiovascular researcher at the Intermountain Medical Center Heart Institute in Salt Lake City. "The risk factors deserve to be known, but they do not say whether or not you actually have the disease."
Cardiovascular disease remains the leading cause of morbidity and mortality in the United States, and determining who is at greatest risk remains suboptimal, said Dr. Anderson.
Two-thirds of Americans with cardiovascular disease belong to a very large group, and this was traditionally considered the low-risk part of the population based on standard risk factors, which means that a large number of people at risk are missed during screenings.
In the new study, researchers at the Intermountain Medical Center Heart Institute, part of the Intermountain health care system, identified 1,107 symptomatic patients who presented to the health care system without any known coronary heart disease who had underwent a PET stress test to measure coronary artery disease. flow, conducted as part of their diagnostic evaluation.
The PET / CT test also measured a coronary calcium score. Based on the coronary calcium score and standard risk factors documented in their medical records, three different risk scores for atherosclerotic cardiovascular disease were calculated: the standard equation of the pooled cohort (based on traditional risk), the multiethnic study of the risk of atherosclerosis (MESA) score (which combines coronary calcium and traditional risk factors), and the coronary calcium score alone
The researchers followed these patients to determine who, based on PET findings suggesting a blocked artery, underwent revascularization (coronary stent graft or bypass graft) and who had a heart attack or died within two years. following.
They found that risk equations that included measurements of calcium in the coronary arteries, ie. The MESA score and the coronary calcium risk score, were better able to predict the presence of symptomatic coronary artery disease requiring revascularization compared to the pooled cohort equation, which relies solely on the standard risk of factors such as age, sex, blood pressure and cholesterol measurements.
However, after exploiting the PET-scan results, all three equations were only moderately successful in determining who, after two years of follow-up, would die or have a heart attack. It should be noted, however, that of the 29 patients who had no calcium in the coronary arteries, none had a major cardiac problem during the study period.
The researchers presented the results of the study at the 2018 scientific session of the American Heart Association in Chicago.
"The calcium in the artery does not tell you the extent of the soft plaque, but it indicates that the disease is present," said Dr. Anderson. "These results tell us that coronary calcium adds a lot to probability estimates."
He also said that the cost of coronary calcium screening is low, in the range of $ 100 or less, and should be considered in the future as part of routine medical care after the first day of treatment. age 50 for men and 55 to 60 for women.
"We admit that mammograms should be performed for women and colonoscopies for everyone at a certain age, and that they are much more expensive than a calcium scanner," he said. .
Dr. Anderson hopes that these results will lead to better acceptance of coronary calcium tests and their coverage by health insurance to better predict who has coronary risk, which will not only lead to high risk patients treat earlier, but will also keep patients who are not. do not really risk being over-treated.
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