Authors' objectives:

This review aims to assess the available evidence on electron-beam and helical computed tomography for coronary artery disease.

Authors' recommendations: With respect to the measurement of coronary artery calcification the ICSI Technology Assessment Committee finds: - No study has reported the use of coronary artery calcification (CAC) detection or measurement to reduce myocardial infarction or coronary death. - In asymptomatic persons electron-beam computed tomography (EBCT) tests for CAC: a. Are not recommended as a screening test in the absence of risk factors. b. May be useful as a screening test if one or a few risk factors are present (intermediate risk patients) and the test could be helpful in determining the need to begin a primary prevention regimen c. Have been found to be better than conventional risk factors alone in predicting future coronary artery events in high risk patients (Conclusion Grade I). However, risk factor assessment and other non-invasive tests are more widely available. EBCT is not usually necessary to start primary prevention treatment when diabetes or multiple risk factors are present. d. Are highly sensitive but not specific enough in the individual patient to use for diagnosis or exclusion of coronary obstruction or stenosis (Conclusion Grade II). - In patients with symptoms of coronary artery disease the issue is not primary prevention but diagnosis and management. For diagnosis of obstructive coronary artery disease, coronary artery calcification is a stronger independent predictor than risk factors. Direct comparisons of EBCT with other non-invasive tests for diagnosis are lacking. - Serial EBCT calcium scores indicate that the development of coronary artery calcification is slowed during lipid-lowering therapy. The clinical significance of this is unknown. - EBCT and helical computed tomography (CT) are safe procedures; there is no direct harm to the patient. The potential for inappropriate and invasive follow-up must be considered. - Practitioners should use caution when comparing calcium scoring from different types of scanners (helical CT and EBCT). The use of helical CT to assess coronary artery calcification is not as well documented as is EBCT. There are insufficient data on the predictive value of a calcium score calculated from a helical CT scan (Conclusion Grade III). Although there are no prognostic data comparing the results of helical CT or EBCT studies, there are differences between the procedures that would suggest that findings from EBCT studies cannot be applied to helical CT studies.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.icsi.org/knowledge/detail.asp?catID=107&itemID=280

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Institute for Clinical Systems Improvement

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Contact Name: icsi.info@icsi.org

Contact Email: icsi.info@icsi.org

Copyright: Institute for Clinical Systems Improvement (ICSI)