Seminars in Ultrasound, CT and MRI
Volume 29, Issue 3 , Pages 223-229 , June 2008

Coronary Artery Calcium Scanning Using Computed Tomography: Clinical Recommendations for Cardiac Risk Assessment and Treatment

  • John A. Rumberger, MD, PhD, FACC

      Affiliations

    • Corresponding Author InformationAddress reprint requests to: John A. Rumberger, MD, PhD, FACC, The Princeton Longevity Center, Princeton Forrestall Village, 136 Main Street, Princeton, NJ 08540.

References 

  1. Heart and Stoke Statistical Update. Dallas, TX: American Heart Association; 2001;
  2. Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circulation. 1995;92:657–671
  3. Raggi P, Callister TQ, Cooil B, et al. Identification of patients at increased risk of first unheralded acute myocardial infarction by electron beam computed tomography. Circulation. 2000;101:850–855
  4. Wong ND, Hsu JC, Detrano RC, et al. Coronary artery calcium evaluation by electron beam computed tomography and its relation to new cardiovascular events. Am J Cardiol. 2000;86:495–498
  5. Arad Y, Spadaro L, Goodman K, et al. Prediction of coronary events with electron beam computed tomography. J Am Coll Cardiol. 2000;36:1253–1260
  6. Kondos GT, Hoff JA, Sevrukov A, et al. Coronary artery calcium and cardiac events electron-beam tomography coronary artery calcium and cardiac events: a 37-month follow-up of 5,635 initially asymptomatic low to intermediate risk adults. Circulation. 2003;107:2571–2576
  7. Shaw LJ, Raggi P, Schisterman E, et al. Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology. 2003;28:826–833
  8. Greenland P, LaBree L, Azen SP, et al. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004;291:210–215
  9. Arad Y, Goodman KJ, Roth M, et al. Coronary calcification, coronary risk factors (C-reactive protein and atherosclerotic cardiovascular disease events: the St. Francis Heart Study). J Am Coll Cardiol. 2005;46:158–165
  10. Schmermund A, Denktas AE, Rumberger JA, et al. Independent and incremental value of coronary artery calcium for predicting the extent of angiographic coronary artery disease: comparison with cardiac risk factors and radionuclide perfusion imaging. J Am Coll Cardiol. 1999;34:777–786
  11. DeBacker G, Ambrosioni E, Borch-Johnson K, et al. European guidelines on cardiovascular disease prevention in clinical practice (Third joint task force of European and other countries in cardiovascular disease in clinical practice). Eur J Rehab Prev. 2003;10(suppl 1):S1–S78
  12. Mieres JH, Shaw LJ, Andrew Arai A, et al. AHA Scientific statement: role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease (Consensus Statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association). Circulation. 2005;111:682–696
  13. Leber AW, Becker A, Knez A, et al. Accuracy of 64-slice computed tomography to classify and quantify plaque volume in the proximal coronary system. JACC. 2006;47:672–677
  14. Wilson PWF, D'Agostino B, Levy D, et al. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837–1847
  15. Grundy SM, Cleeman JI, Merz CNB, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110:227–239
  16. Rifkin RD, Parisi AF, Folland E. Coronary calcification in the diagnosis of coronary artery disease. Am J Cardiol. 1979;44:141–147
  17. McCarthy JH, Palmer FJ. Incidence and significance of coronary artery calcification. Br Heart J. 1974;36:499–506
  18. Rumberger JA, Simons DB, Fitzpatrick LA, et al. Coronary artery calcium areas by electron beam computed tomography and coronary atherosclerotic plaque area: a histopathologic correlative study. Circulation. 1995;92:2157–2162
  19. Baumgart D, Schmermund A, Goerge G, et al. Comparison of electron beam computed tomography with intracoronary ultrasound and coronary angiography for detection of coronary atherosclerosis. J Am Coll Cardiol. 1997;30:57–64
  20. Schmermund A, Baumgart D, Gorge G, et al. Coronary artery calcium in acute coronary syndromes: a comparative study of electron beam CT (coronary angiography, and intracoronary ultrasound in survivors of acute myocardial infarction and unstable angina). Circulation. 1997;96:1461–1469
  21. Agatston AS, Janowitz WR, Hildner FJ, et al. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827–832
  22. Rumberger JA, Brundage BH, Rader DJ, et al. Electron beam CT coronary calcium scanning: a review and guidelines for use in asymptomatic individuals. Mayo Clin Proc. 1999;74:243–252
  23. Callister TQ, Cooil B, Raya SP, et al. Coronary artery disease: improved reproducibility of calcium scoring with an electron-beam CT volumetric method. Radiology. 1998;208:807–814
  24. Hoff JA, Chomka EV, Krainik AJ, et al. Age and gender distributions of coronary artery calcium detected by electron beam tomography in 35,246 adults. Am J Cardiol. 2001;87:1335–1339
  25. Schmermund A, Erbel R, Silber S. Age and gender distribution of coronary artery calcium measured by four-slice computed tomography in 2,030 persons with no symptoms of coronary artery disease. Am J Cardiol. 2002;90:169–173
  26. Budoff MJ, Yang TP, Shavelle RM. Ethnic differences in coronary atherosclerosis. J Am Coll Cardiol. 2002;39:408–412
  27. Newman AB, Naydeck BL, Whittle J, et al. Racial differences in coronary artery calcification in adults. Arterioscler Thromb Vasc Biol. 2002;22:424–430
  28. Khuran C, Rosenbaum CG, Howard BV, et al. Coronary artery calcification in black women and white women. Am Heart J. 2003;145:724–729
  29. Jain T, Peshock R, Darren K, et al. African Americans and Caucasians have a similar prevalence of coronary calcium in the Dallas Heart Study. J Am Coll Cardiol. 2004;44:1011–1017
  30. Budoff MJ, Shaw LJ, Liu ST, et al. Long term prognosis associated with coronary calcium: observations from a registry of 25,253 patients. JACC. 2007;49:1860–1870
  31. Nasir K, Shaw LJ, Liu ST, et al. Ethnic Differences in the prognostic value of coronary artery calcification for all-cause mortality. JACC. 2007;50:953–960
  32. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Final Report. NIH Publication No. 02-5215. September 2002
  33. Tuzcu EM, Kapadia SR, Tutar E, et al. High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults: evidence from intravascular ultrasound. Circulation. 2001;103:2705–2710
  34. Budoff MJ, Ehrlich J, Hecht HS, et al. Letter to the Editor. JAMA. 2004;291:1822
  35. Greenland P, Smith SC, Grundy SM. Improving coronary heart disease risk assessment in asymptomatic people: role of traditional risk factors and noninvasive cardiovascular tests. Circulation. 2001;104:1863–1867
  36. O'Rourke RA, Brundage BH, Froelicher VF, et al. American College of Cardiology/American Heart Association expert consensus document on electron beam computed tomography for the diagnosis and prognosis of coronary artery disease. Circulation. 2000;102:126–134
  37. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) (Adult Treatment Panel III). JAMA. 2001;285:2486–2497
  38. Pohle K, Ropers D, Mäffert R, et al. Coronary calcifications in young patients with first, unheralded myocardial infarction: a risk factor matched analysis by electron beam tomography. Heart. 2003;89:625–628
  39. Smith SC, Greenland P, Grundy SM. Prevention Conference V: beyond secondary prevention: identifying the high-risk patient for primary prevention (Executive Summary). Circulation. 2000;101:111–116
  40. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomized placebo-controlled tria. Lancet. 2002;360:7–22
  41. Raggi P, Cooil B, Callister TQ. Use of electron beam tomography data to develop models for prediction of hard coronary events. Am Heart J. 2001;141:375–382
  42. Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation. 2004;110:227–239
  43. Raggi P, Shaw LJ, Berman DS, et al. Prognostic value of coronary artery calcium screening in subjects with and without diabetes. J Am Coll Cardiol. 2004;43:1663–1669
  44. Callister TQ, Raggi P, Cooil B, et al. Effect of HMG-CoA reductase inhibitors on coronary artery disease as assessed by electron beam computed tomography. N Engl J Med. 1998;339:1972–1978
  45. Budoff MJ, Lane KL, Bakhsheshi H, et al. Rates of progression of coronary calcium by electron beam tomography. Am J Cardiol. 2000;86:8–11
  46. Achenbach S, Ropers D, Pohle K, et al. Influence of lipid-lowering therapy on the progression of coronary artery calcification: a prospective evaluation. Circulation. 2002;106:1077–1082
  47. Shavelle DM, Takasu J, Budoff MJ, et al. HMG CoA reductase inhibitor (statin) and aortic valve calcium. Lancet. 2002;359(9312):1125–1126
  48. Raggi P, Cooil B, Shaw L, et al. Progression of coronary calcification on serial electron beam tomography scanning is greater in patients with future myocardial infarction. Am J Cardiol. 2003;92:827–829
  49. Raggi P, Callister TQ, Shaw LJ. Progression of coronary artery calcium and risk of first myocardial infarction in patients receiving cholesterol-lowering therapy. Arterioscler Thromb Vasc Biol. 2004;24:1–7
  50. Hecht HS, Harman SM. Changes in calcified plaque and serum lipoprotein values: evaluation by electron beam tomography in treated and untreated asymptomatic patients. Am J Cardiol. 2003;91:1131–1134
  51. Diamond GA, Forester JS. Analysis of probability as an aid in the clinical diagnosis of coronary artery disease. N Engl J Med. 1979;300:1350–1358
  52. He Z, Hedrick TD, Pratt CM, et al. Severity of coronary calcification by electron beam computed tomography predicts silent myocardial ischemia. Circulation. 2000;101:244–251
  53. Berman DS, Wong ND, Gransar H, et al. Relationship between stress-induced myocardial ischemia and atherosclerosis measured by coronary calcium tomography. J Am Coll Cardiol. 2004;44:923–930
  54. Haberl R, Becker A, Leber A, et al. Correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: results of 1,764 patients. J Am Coll Cardiol. 2001;37:451–457

PII: S0887-2171(08)00019-X

doi: 10.1053/j.sult.2008.02.008

Seminars in Ultrasound, CT and MRI
Volume 29, Issue 3 , Pages 223-229 , June 2008

Article Tools

* Image Usage & Resolution