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Electron Beam Tomography: The Most Powerful Screening Test
EBT: Imaging for the VP PyramidEBT: Imaging for the VP Pyramid
How Good Is NCEP III At Predicting MI?How Good Is NCEP III At Predicting MI?JACC 2003:41 1475-9JACC 2003:41 1475-9
222 patients with 1222 patients with 1stst acute MI, no prior CAD acute MI, no prior CADmen <55 y/o (75%), women <65 (25%), no DMmen <55 y/o (75%), women <65 (25%), no DM
RiskRisk>20%/>20%/10 yrs.10 yrs.
RiskRisk10-20%/10-20%/10 yrs.10 yrs.
RiskRisk<10%/<10%/10 yrs.10 yrs.
NCEP GoalNCEP GoalLDL<100LDL<100
NCEP GoalNCEP GoalLDL<160LDL<160
NCEP GoalNCEP GoalLDL<130LDL<130
Qualify for Rx
Not-Qualify for Rx
6%6% 6%6%
TotalTotal
12%12%8%8% 10%10%
TotalTotal
18%18%
61%61%
9%9%
TotalTotal
70%70%
88% of these “young” patients who suffered afirst Myocardial Infarction were in the
Low to Intermediate “risk” category accordingTo Framingham Risk Assessment and
would have been missed as truly “High Risk” individuals who should
have been treated “aggressively”
EBT: Imaging for the VP PyramidEBT: Imaging for the VP Pyramid
All Cause Mortality [NDR]All Cause Mortality [NDR]n = 10,377n = 10,377asymptomatic men and womenasymptomatic men and womenf/u = 5.0f/u = 5.0++3.5 yrs.3.5 yrs.
Shaw,Radiology 2003;228:826-833
EBT found to be independentand incremental to risk factors826-833
All Cause Mortality in PatientsAll Cause Mortality in PatientsWithout Known CADWithout Known CAD
EBT: Imaging for the VP PyramidEBT: Imaging for the VP Pyramid
At At PRESENTPRESENT the following has been established: the following has been established:
o Coronary calcium IS AtherosclerosisCoronary calcium IS Atherosclerosis
o The magnitude of the calcium score relates to the severity of ASO diseaseThe magnitude of the calcium score relates to the severity of ASO disease
o The calcium score as well as the percentile rank provide informationThe calcium score as well as the percentile rank provide information
in which to view risk factors, rather than the other way aroundin which to view risk factors, rather than the other way around
o The data on examining progression of CAD with CT are consistent withThe data on examining progression of CAD with CT are consistent with
the potential for the calcium score/rank to be used as the “goal” of therapythe potential for the calcium score/rank to be used as the “goal” of therapy
EBT: Imaging for the VP PyramidEBT: Imaging for the VP Pyramid
The calcium score is a measure of overall disease extent in a given person and is aconsequence of a variety of factors related to genetics, habits, environment andsusceptibility to inflammation and many ofThese are not “measurable” by blood tests.
So, it might make more sense to use EBT as anadditional risk factor and incorporate its results with conventional assessments
EBT: Imaging for the VP PyramidEBT: Imaging for the VP Pyramid