Original articleUse of coronary calcium scanning for predicting inducible myocardial ischemia: Influence of patients’ clinical presentation
Section snippets
Study cohort
The study participants comprised 648 patients (mean age, 58 ± 10.6 years; 62% men) who underwent CAC scanning on a prospective research basis (as part of the Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research [EISNER] study), after first undergoing physician-ordered exercise-rest MPS scanning at Cedars-Sinai Medical Center (Los Angeles, Calif), usually because of chest pain symptoms or the presence of coronary risk factors (or both). CAC scanning was performed
Results
The clinical characteristics of our recruited patients are shown in Table 1, divided according to chest pain grouping. Patients who were asymptomatic had the lowest mean likelihood of ASCAD and those with typical angina had the highest mean likelihood of ASCAD before MPS testing, but the chest pain groups did not differ significantly in the distribution and number of CAD risk factors. Exercise duration was lowest and the frequencies of exercise-induced chest pain, ST-segment depression, and MPS
Discussion
Because formation of calcium-containing atherosclerotic plaque generally precedes the development of clinically overt CAD by many years, CAC scanning has been proposed as a means of screening for subclinical atherosclerosis before clinical symptoms become manifest. However, clinical estimates of the likelihood of ASCAD, and not CAC, are most commonly used in judging the appropriateness of patients’ referral for cardiac stress testing.1, 2 To date, comparisons of CAC measurements to ASCAD
Acknowledgment
The authors have indicated they have no financial conflicts of interest.
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This study was supported by a grant from The Eisner Foundation, Los Angeles, Calif.