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

2. HEART DISEASE IS THE LEADING CAUSE OF DEATH IN THE INDUSTRIALIZED WORLD HEART DISEASE IS THE LEADING CAUSE OF DEATH IN THE INDUSTRIALIZED WORLD

3. 50% OF PEOPLE WHO DIE FROM HEART DISEASE HAVE AN ACUTE MYOCARDIAL INFARCTION OR SUDDEN DEATH AS THEIR FIRST PRESENTATION 50% OF PEOPLE WHO DIE FROM HEART DISEASE HAVE AN ACUTE MYOCARDIAL INFARCTION OR SUDDEN DEATH AS THEIR FIRST PRESENTATION

4. Over 50% of MI’s occur in patients who are low or intermediate risk using traditional risk factors 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 Up to 30% of diagnostic coronary caths are negative

5. A QUICK, EASY, ACCURATE, NON- INVASIVE TEST FOR SIGNIFICANT CORONARY ARTERY DISEASE WOULD BE HIGHLY DESIRABLE AS HEART DISEASE HAS BECOME MORE TREATABLE A QUICK, EASY, ACCURATE, NON- INVASIVE TEST FOR SIGNIFICANT CORONARY ARTERY DISEASE WOULD BE HIGHLY DESIRABLE AS HEART DISEASE HAS BECOME MORE TREATABLE

6. CORONARY ARTERY CALCIFICATION HAS BEEN SHOWN TO BE A MARKER FOR CORONARY ARTERY ATHEROSCLEROSIS CORONARY ARTERY CALCIFICATION HAS BEEN SHOWN TO BE A MARKER FOR CORONARY ARTERY ATHEROSCLEROSIS

7. CALCIFICATION CAN BE SEEN WITH FLUOROSCOPY AND ON CHEST X-RAY CALCIFICATION CAN BE SEEN WITH FLUOROSCOPY AND ON CHEST X-RAY COMPUTED TOMOGRAPHY ALLOWS QUANTIFICATION OF THIS CALCIUM COMPUTED TOMOGRAPHY ALLOWS QUANTIFICATION OF THIS CALCIUM

8. SCORES ARE BASED ON MEASURED AREA AND PEAK CT NUMBER WITHIN THE BORDERS OF EACH CORONARY ARTERY. SCORES ARE BASED ON MEASURED AREA AND PEAK CT NUMBER WITHIN THE BORDERS OF EACH CORONARY ARTERY. WE USED THE AGATSTON METHOD WE USED THE AGATSTON METHOD

9. PATIENTS WERE SCANNED USING NON-CONTRASTED 2.5 MM SLICES THROUGH THE HEART PATIENTS WERE SCANNED USING NON-CONTRASTED 2.5 MM SLICES THROUGH THE HEART EXAM IS PERFORMED DURING A SINGLE BREATH HOLD EXAM IS PERFORMED DURING A SINGLE BREATH HOLD

10. THESE STUDIES MUST BE EKG GATED IN ORDER TO DECREASE MOTION ARTIFACT THESE STUDIES MUST BE EKG GATED IN ORDER TO DECREASE MOTION ARTIFACT SCANS ARE OBTAINED AT 80% OF THE R-R INTERVAL SCANS ARE OBTAINED AT 80% OF THE R-R INTERVAL

11. PATIENTS WERE SELF-REFERRED AND ASYMPTOMATIC AT THE TIME OF THE CT SCAN PATIENTS WERE SELF-REFERRED AND ASYMPTOMATIC AT THE TIME OF THE CT SCAN ALL EXAMS WERE DONE ON THE SAME 4 DETECTOR SCANNER ALL EXAMS WERE DONE ON THE SAME 4 DETECTOR SCANNER

12. 3,368 people were screened between 2000 and 2003 3,368 people were screened between 2000 and 2003 1793 men 1793 men 1575 women 1575 women Age : 21-92 (54 ± 9.4 years) Age : 21-92 (54 ± 9.4 years) Average follow-up was 16 months(3-30 months) Average follow-up was 16 months(3-30 months)

14. males

15. females

16. total

17. 19% of patients who reported having diabetes had scores over 400 19% of patients who reported having diabetes had scores over 400 8% of the total population had scores over 400 8% of the total population had scores over 400 p<.0001 p<.0001

18. 277 people (8%) had scores over 400. 277 people (8%) had scores over 400. Of these 69 (25%) underwent coronary angiography Of these 69 (25%) underwent coronary angiography

19. 58/69 (84%) had a coronary artery with at least a 50 % stenosis by angiography 58/69 (84%) had a coronary artery with at least a 50 % stenosis by angiography

20. 44/69 (64%) had an intervention including: 44/69 (64%) had an intervention including: Angioplasty Angioplasty Stent placement Stent placement And/or coronary artery bypass grafting And/or coronary artery bypass grafting

21. In this study group there were 7 confirmed deaths In this study group there were 7 confirmed deaths 6/7 (86%) occurred in the over 400 group 6/7 (86%) occurred in the over 400 group

22. Mortality ≥ 400 = 2.2% Mortality ≥ 400 = 2.2% Mortality < 400 = 0.03% Mortality < 400 = 0.03% p<.0001 p<.0001

23. 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 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% 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) p=.24 (not significant) We will continue to follow these patients to see if a trend develops over time We will continue to follow these patients to see if a trend develops over time

24. % of subjects who had measurable calcium in specific arteries

25. Calcium score and angiogram results were evaluated for the left main, LAD, circumflex, and right coronary arteries 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 An angiogram was considered positive if there was a 50% or greater stenosis

26. T-tests were performed to evaluate for an association between the calcium score in a specific artery and the angiogram results for that artery 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 None of the four tests showed a significant association

27. CT CORONARY CALCIUM SCORING DOES NOT: CT CORONARY CALCIUM SCORING DOES NOT: PREDICT WHICH SPECIFIC CORONARY ARTERIES ARE STENOTIC PREDICT WHICH SPECIFIC CORONARY ARTERIES ARE STENOTIC PROVIDE ENOUGH INFORMATION TO BE CERTAIN WHO DOES AND WHO DOES NOT NEED INTERVENTION PROVIDE ENOUGH INFORMATION TO BE CERTAIN WHO DOES AND WHO DOES NOT NEED INTERVENTION

28. A HIGH CT CORONARY CALCIUM SCORE IS ASSOCIATED WITH: A HIGH CT CORONARY CALCIUM SCORE IS ASSOCIATED WITH: DIABETES DIABETES INCREASING AGE INCREASING AGE CORONARY ATHROSCLEROSIS CORONARY ATHROSCLEROSIS SIGNIFICANT LUMINAL NARROWING SIGNIFICANT LUMINAL NARROWING INCREASED MORTALITY INCREASED MORTALITY INCREASED CARDIAC DEATH INCREASED CARDIAC DEATH

29. 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 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