Enter Your Email Address to Receive a
Copy of MedicExhange Member Demograhpics

The Journal of the American College of Cardiology says Coronary artery calcium scans can be done without triggering excessive additional testing and costs, according to the multi-center EISNER study, led by investigators at the Cedars-Sinai Heart Institute.

A simple, non-invasive test appears to be an effective screening tool for identifying patients with silent heart disease who are at risk for a heart attack or sudden death. Coronary artery calcium scans can be done without triggering excessive additional testing and costs, according to the multi-center EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) study, led by investigators at the Cedars-Sinai Heart Institute.

Coronary artery calcium scans that detect plaque in the coronary arteries have been shown to be more effective than standard cholesterol and blood pressure measurements in identifying patients who are most vulnerable to heart disease. Currently, these scans are not covered by private insurance carriers, in part because of concerns that detection of low levels of cardiovascular disease will result in unnecessary and expensive further testing, including exercise imaging and invasive cardiac catheterization procedures.

In the EISNER study, supported by The Eisner Foundation, researchers performed coronary calcium scans on 1,361 volunteers at intermediate risk for coronary artery disease, and followed them over a four-year period, from May 2001 to June 2005. The objective was to determine the relationship between coronary artery calcium scores and subsequent cardiac events and to evaluate the performance of additional cardiac diagnostic testing. Coronary artery calcium scores of 0 indicate no plaque, 1-9 minimal, 10-99 mild, 100-399 moderate, 400-999 extensive, and 1,000 or more very extensive plaque.

Coronary artery calcium scores varied widely but the vast majority of the patients had low scores. More than half — 56.7 percent of subjects -- had scores of less than 10, and only 8.2 percent had scores higher than 400. There was a strong relationship between the coronary calcium scores and subsequent cardiac events. The unique finding of the EISNER study was that there was a marked difference in the number, type and frequency of medical tests and costs given a subject's coronary artery calcium score.

Recent evidence has demonstrated that screening with coronary artery calcium is a better prognosticator of risk than the Framingham Risk Score—the traditional way of assessing risk based on blood testing and blood pressure--in middle aged and elderly patients. Yet controversy surrounds expansion of cardiac screening to include coronary calcium scanning imaging because of concerns that the extra costs may not outweigh the benefits. The findings of the EISNER study, the researchers note, is the first direct evidence that coronary artery calcium scanning could be an acceptable cost-effective screening test for coronary artery disease, since it is able to identify high risk subgroups in need of aggressive medical treatment, and patients who undergo additional testing constitute only a small fraction of the screened population.

The study was funded by a grant from The Eisner Foundation, a private philanthropy in Los Angeles.

Source: EISNER

You can discuss more about Cardiology and related topics in our Cardiology Group.