Electron beam computed tomographic coronary calcium scanning: A review andguidelines for use in asymptomatic persons

Coronary artery disease is the No. 1 cause of death in the developed world. Effective means of treatment such as drug therapy to lower cholesterol lev els are available, but clinical application to patients at highest risk rem ains imprecise. Electron beam computed tomography (EBCT) has been suggested as a means to diagnose subclinical coronary disease and facilitate risk st ratification, but no current interpretive consensus exists in clinical prac tice. We critically reviewed current, pertinent literature regarding EBCT c oronary calcium scanning from a clinical perspective and, in particular, st udies that evaluated it as a measure of atherosclerotic coronary disease, A dditionally, me reviewed studies that quantified the EBCT "calcium score" i n relationship to coronary heart disease events, The available data suggest that the EBCT calcium score can help identify persons at higher than antic ipated risk of future coronary events: the greater the EBCT coronary calciu m score, the greater the extent of atherosclerotic plaque disease, Based on the literature review, we offer EBCT interpretation guidelines as they rel ate to drug therapy and risk reduction in asymptomatic persons with borderl ine cholesterol levels, Considerable evidence shows that coronary calcium i s specific for atherosclerotic plaque and that it can be sensitively detect ed and accurately quantified by using EBCT, The coronary calcium score can help guide initiation of clinical prevention programs as part of a risk str atification and management scheme aimed at improving outcomes in patients d etermined to be at highest risk of coronary disease for their respective ag e and gender.