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Screening for Coronary Artery Calcium with Computed Tomography: Angiography and Intervention in Patients with Scores Ove PowerPoint Presentation
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Screening for Coronary Artery Calcium with Computed Tomography: Angiography and Intervention in Patients with Scores Ove - PowerPoint PPT Presentation


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Screening for Coronary Artery Calcium with Computed Tomography: Angiography and Intervention in Patients with Scores Over 400 W. Goodwin, M. Fuseini, J. Norton, J.Mehta, E. Ferris; University of Arkansas for Medical Sciences, Little Rock, AR .

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Screening for Coronary Artery Calcium with Computed Tomography: Angiography and Intervention in Patients with Scores Over 400

W. Goodwin, M. Fuseini, J. Norton, J.Mehta, E. Ferris; University of Arkansas for Medical Sciences, Little Rock, AR

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50% OF PEOPLE WHO DIE FROM HEART DISEASE HAVE AN ACUTE MYOCARDIAL INFARCTION OR SUDDEN DEATH AS THEIR FIRST PRESENTATION
slide4
Over 50% of MI’s occur in patients who are low or intermediate risk using traditional risk factors
  • Up to 30% of diagnostic coronary caths are negative
slide5
A QUICK, EASY, ACCURATE, NON-INVASIVE TEST FOR SIGNIFICANT CORONARY ARTERY DISEASE WOULD BE HIGHLY DESIRABLE AS HEART DISEASE HAS BECOME MORE TREATABLE
slide7
CALCIFICATION CAN BE SEEN WITH FLUOROSCOPY AND ON CHEST X-RAY
  • COMPUTED TOMOGRAPHY ALLOWS QUANTIFICATION OF THIS CALCIUM
slide8
SCORES ARE BASED ON MEASURED AREA AND PEAK CT NUMBER WITHIN THE BORDERS OF EACH CORONARY ARTERY.
  • WE USED THE AGATSTON METHOD
slide9
PATIENTS WERE SCANNED USING NON-CONTRASTED 2.5 MM SLICES THROUGH THE HEART
  • EXAM IS PERFORMED DURING A SINGLE BREATH HOLD
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THESE STUDIES MUST BE EKG GATED IN ORDER TO DECREASE MOTION ARTIFACT
  • SCANS ARE OBTAINED AT 80% OF THE R-R INTERVAL
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PATIENTS WERE SELF-REFERRED AND ASYMPTOMATIC AT THE TIME OF THE CT SCAN
  • ALL EXAMS WERE DONE ON THE SAME 4 DETECTOR SCANNER
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3,368 people were screened between 2000 and 2003
  • 1793 men
  • 1575 women
  • Age : 21-92 (54 ± 9.4 years)
  • Average follow-up was 16 months(3-30 months)
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19% of patients who reported having diabetes had scores over 400
  • 8% of the total population had scores over 400
  • p<.0001
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277 people (8%) had scores over 400.
  • Of these 69 (25%) underwent coronary angiography
slide20
44/69 (64%) had an intervention including:
  • Angioplasty
  • Stent placement
  • And/or coronary artery bypass grafting
slide21
In this study group there were 7 confirmed deaths
  • 6/7 (86%) occurred in the over 400 group
slide22
Mortality ≥ 400 = 2.2%
  • Mortality < 400 = 0.03%
  • p<.0001
slide23
Mortality in the group who had scores over 400 and who had an intervention was 2/44 or 4.5%

Mortality in the group who had scores over 400 and who did not have an intervention was 4/233 or 1.7%

p=.24 (not significant)

We will continue to follow these patients to see if a trend develops over time

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Calcium score and angiogram results were evaluated for the left main, LAD, circumflex, and right coronary arteries
  • An angiogram was considered positive if there was a 50% or greater stenosis
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T-tests were performed to evaluate for an association between the calcium score in a specific artery and the angiogram results for that artery
  • None of the four tests showed a significant association
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CT CORONARY CALCIUM SCORING DOES NOT:
  • PREDICT WHICH SPECIFIC CORONARY ARTERIES ARE STENOTIC
  • PROVIDE ENOUGH INFORMATION TO BE CERTAIN WHO DOES AND WHO DOES NOT NEED INTERVENTION
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A HIGH CT CORONARY CALCIUM SCORE IS ASSOCIATED WITH:
  • DIABETES
  • INCREASING AGE
  • CORONARY ATHROSCLEROSIS
  • SIGNIFICANT LUMINAL NARROWING
  • INCREASED MORTALITY
  • INCREASED CARDIAC DEATH
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CALCIFICATION OF THE CORONARY ARTERIES WILL CONTINUE TO BE RELEVANT BECAUSE OF ITS RELATIONSHIP TO HEART DISEASE AND DUE TO ITS EFFECT ON CT ANGIOGRAPHY OF THE CORONARY ARTERIES