Vulnerable Plaque Symposium Vulnerable Plaque Symposium Patients with High CRP & High Patients with High CRP & High CT Calcium Score are at Higher CT Calcium Score are at Higher Risk: Risk: How Can Calcium Score How Can Calcium Score Improve Your Practice? Improve Your Practice? John A. Rumberger, PhD, MD, FACC John A. Rumberger, PhD, MD, FACC nical Professor of Medicine, Ohio State Universi nical Professor of Medicine, Ohio State Universi Medical Director Medical Director Physician’s Prevention and Wellness Center Physician’s Prevention and Wellness Center Columbus, Ohio Columbus, Ohio Chicago, IL Chicago, IL March 29, 2003 March 29, 2003 2003 John A Rumberger, MD
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Patients with High CRP & HighPatients with High CRP & HighCT Calcium Score are at Higher Risk:CT Calcium Score are at Higher Risk:
How Can Calcium ScoreHow Can Calcium ScoreImprove Your Practice?Improve Your Practice?
John A. Rumberger, PhD, MD, FACCJohn A. Rumberger, PhD, MD, FACCClinical Professor of Medicine, Ohio State UniversityClinical Professor of Medicine, Ohio State University
Medical DirectorMedical Director Physician’s Prevention and Wellness CenterPhysician’s Prevention and Wellness Center
Columbus, OhioColumbus, OhioChicago, ILChicago, IL
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
RR of non-fatal MI/Cardiac Death: EBT Score and hs-CRP
6.3 4.3
1.74.9
1.8 10
2
4
6
8
High CAC Med. CAC Low CAC
Lowest quartile hs-CRP
Highest quartile hs-CRP
Park et al.Circ. 2002;106-2073-2077
6.3
Rel
ativ
e R
isk
Rel
ativ
e R
isk
6.4 yr. f/u, n = 967initially asymptomatic,non-diabetic individuals
Prediction of MI/SCD in Asymptomatic Patients:Prediction of MI/SCD in Asymptomatic Patients:EBTEBT
0
1
2
3
4
5
6
7
0 10 20 30 40 50 60 70 80 90
Percentile Rank for Baseline EBCT Calcium ScorePercentile Rank for Baseline EBCT Calcium Score
LowLowRiskRisk
IntermediateIntermediateRiskRisk
HighHighRiskRisk
Prediction of MI/SCD in Asymptomatic Patients:Prediction of MI/SCD in Asymptomatic Patients:EBTEBT
0
1
2
3
4
5
6
7
0 10 20 30 40 50 60 70 80 90
Percentile Rank for Baseline EBCT Calcium ScorePercentile Rank for Baseline EBCT Calcium Score
LowLowRiskRisk
IntermediateIntermediateRiskRisk
HighHighRiskRisk
CRPCRP
Clinical Questions in PreventionClinical Questions in Prevention
In the asymptomatic individual
How aggressive should I be? Primary versus secondary prev. goals
How closely should I follow up? Routine versus close & repeat testing
hs-CRP CAC Range Level of Aggression, f/u
< 1 mg/L
> 1-3 mg/L
> 3 mg/L
hs-CRP & CAC Scoringhs-CRP & CAC Scoring
Value Range Percentile Range Aggression Clinical f/uLowLowLow
Mod.Mod.Mod.
HighHighHigh
<25th Low>25th-<75th Intermed.
>75th High
<25th Low>25th-<75th Intermed.
>75th High
<25th Low>25th-<75th Intermed.
>75th High
Primary RoutinePrimary Routine
Secondary Close
Primary RoutinePrimary Close
Secondary Close
Primary CloseSecondary Close
Secondary Close
hs-CRP & CAC Scoringhs-CRP & CAC Scoring
In “intermediate” risk asymptomatic individualsIn “intermediate” risk asymptomatic individuals
CAC Scanning with CTCAC Scanning with CT&&
hs-CRP testinghs-CRP testingare are ComplementaryComplementary to each other to each other
and the combination of bothand the combination of bothcan be used to refinecan be used to refine
Clinical-Decision making in such patientsClinical-Decision making in such patients