Non-invasive technologies such as electron-beam computed tomography (EBT) and carotid intimal media thickness have contributed significantly to our understanding of the prevalence of pre-clinical atherosclerosis and its consequences. Because most adverse events related to atherosclerosis occur in individuals at an intermediate risk, data suggests that it will be most cost-effective to concentrate screening efforts on this group of patients. This article reviews the current understanding of the prognostic value of coronary artery calcium screening in asymptomatic and symptomatic patients. Current data suggests that elevated calcium scores are predictive of future cardiac events, independently and incrementally to traditional cardiac risk factors. The approximate predictive power is 10-fold for scores > 100, based upon current studies now reported. Coronary artery calcium has outperformed risk factors, highly sensitive C-reactive protein, and carotid intima-media thickness as a predictor of cardiac events in the studies reported to date. Considerable evidence shows that coronary calcium is specific for atherosclerotic plaque and that it can be accurately detected and quantified by EBT. The greater the EBT calcium score, the greater the extent and severity of coronary atherosclerotic disease. Accurate measurement of subclinical coronary atherosclerosis should significantly improve the accuracy of global cardiovascular risk prediction, and allow for tracking of atherosclerosis burden, as well as better prediction of future cardiovascular events.
Keywords: computed tomography, electron beam, prognosis, review, coronary artery calcification, atherosclerosis, multidetector computed tomography
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