Volume 9, Number 7, July-August 2002

Atherosclerosis imaging and coronary calcification
Matthew J Budoff

Recently published data have greatly expanded the applicability of electron beam tomography and electron beam angiography. Guidelines and policy towards these modalities have shifted, with increased recognition of their importance among experts in cardiology, lipidology and preventive medicine. Given the high sensitivity of coronary calcification for the presence of obstructive coronary artery disease (CAD) (95–99%), exclusion of coronary calcium may be useful as a filter prior to invasive diagnostic procedures or hospital admission.
The prognostic power of coronary calcium has been recognised to be superior to risk factor assessment in summary data from nine studies. The presence of coronary calcification was associated with a 10-fold increased risk of cardiovascular events. Several trials have demonstrated slowing of the calcification process under the influence of statin therapy. Data suggest that change in calcium score can be used to assess the efficacy of lipid-lowering therapy and is currently being used as a surrogate end point for a host of pharmaceutical studies.
Electron beam angiography provides non-invasive visualisation of native coronary arteries and bypass grafts. Some current clinical uses include: following non-diagnostic stress tests; for any person with an intermediate likelihood of CAD (where the step to coronary angiography might be premature); for symptomatic persons post-angioplasty and possibly post-stent; for evaluating graft patency post-coronary artery bypass graft (CABG); and for early detection of obstructive CAD in the high-risk person.

Br J Cardiol 2002;9:394-400.

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