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Extending the Use of Coronary Calcium Scanning to Clinical Rather Than Just Screening Populations

Extending the Use of Coronary Calcium Scanning to Clinical Rather Than Just Screening Populations Twenty-five years after its initial development, coronary artery calcium (CAC) scanning has become a relatively inexpensive test that has been extensively validated as a potent noninvasive means for assessing the burden of coronary atherosclerosis in asymptomatic individuals. A proportional relationship between the magnitude of CAC abnormality and the frequency of subsequent cardiac events over long-term follow-up has been consistently demonstrated, including observations from large patient and population-based cohorts. 1–3 Incremental prognostic value over standard clinical assessments including the Framingham Risk Score and other scores of global risk has also been consistently reported. 3 , 4 Consequently, the application of CAC scanning for assessing asymptomatic patients with intermediate clinical risk has now become part of clinical guidelines. 5 , 6 See Article by Engbers et al Information from CAC scanning may be used to favorably alter patient management in clinical practice. As an example, in the Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research (EISNER) trial, subjects were randomized to routine risk management with and without a concomitant CAC scan. 7 In the scan group, incurred costs and intensity of treatment increased with high CAC scores, but decreased in the zero CAC subgroup. This counterbalance resulted in no http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Circulation: Cardiovascular Imaging Wolters Kluwer Health

Extending the Use of Coronary Calcium Scanning to Clinical Rather Than Just Screening Populations

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Copyright
© 2016 American Heart Association, Inc.
Subject
10128; Editorials
ISSN
1941-9651
eISSN
1942-0080
DOI
10.1161/CIRCIMAGING.116.004876
pmid
27165701
Publisher site
See Article on Publisher Site

Abstract

Twenty-five years after its initial development, coronary artery calcium (CAC) scanning has become a relatively inexpensive test that has been extensively validated as a potent noninvasive means for assessing the burden of coronary atherosclerosis in asymptomatic individuals. A proportional relationship between the magnitude of CAC abnormality and the frequency of subsequent cardiac events over long-term follow-up has been consistently demonstrated, including observations from large patient and population-based cohorts. 1–3 Incremental prognostic value over standard clinical assessments including the Framingham Risk Score and other scores of global risk has also been consistently reported. 3 , 4 Consequently, the application of CAC scanning for assessing asymptomatic patients with intermediate clinical risk has now become part of clinical guidelines. 5 , 6 See Article by Engbers et al Information from CAC scanning may be used to favorably alter patient management in clinical practice. As an example, in the Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research (EISNER) trial, subjects were randomized to routine risk management with and without a concomitant CAC scan. 7 In the scan group, incurred costs and intensity of treatment increased with high CAC scores, but decreased in the zero CAC subgroup. This counterbalance resulted in no

Journal

Circulation: Cardiovascular ImagingWolters Kluwer Health

Published: May 1, 2016

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