Fast heart CAT scans have been a screening test in limbo. The exact role and place for this exam, which is becoming more widely available, hasn’t been well defined, until now.

The heart CAT scan has kind of been a pariah among major prevention groups. Fast CAT scans of the heart can show the amount of calcium in the coronary arteries, which can only be caused by heart blockages.

But does finding calcium help in preventing major events like a heart attack? The latest research shows, in the right patients, it can. It says that one in three Americans between the ages of 40 to 70 should be getting this test, a fast CAT scan of the heart to detect calcium in the coronary arteries.

Dr. Nathaniel Reicheck of St. Francis Hospital says while looking at one scan, “All of this bright stuff is calcium in this patient’s right coronary artery. People with advanced coronary disease often get this kind of heavy calcification.”

The new study in next week’s Journal of the American College of Cardiology shows heart CAT scans can be a highly useful predictor of a heart attack.

The researchers studied nearly 5000 seemingly healthy patients for more than 4 years and used a fast heart CAT scan like this one to measure the amount of calcium in the coronary arteries. They found that it is a better predictor of heart attack risk then conventional risk factors like high blood pressure high cholesterol and a history of smoking.

Dr. Alan Guerci, chief executive officer of St. Francis Hospital and the study’s author, says the heart CAT scan is ready for prime time for many patients. “It’s been understood for more than five years that this test predicts who is going to have a heart attack and who isn’t, who is going to need bypass and who isn’t. The study looks at whether the fast heart CAT scan predicts events like heart attacks, independently of standard risk factors, and it answers that question unequivocally.”

Guerci’s research shows calcium scoring using the heart CAT scan is appropriate for those considered at intermediate risk for coronary artery disease. That’s about a third of all Americans ages 40 through 70!
Intermediate risk means between a 10 and 20 percent risk of heart attack over ten years. It’s based on something called the Framingham Risk Index, which calculates a patient's risk for a heart attack or stroke in the next 10 years based on factors such as age, cholesterol, hypertension, smoking and diabetes.

Detecting early that these patients are at risk can identify those in need of treatment methods, such as aggressive cholesterol lowering. “On the other hand in this intermediate risk group we were able to identify many who were at very low risk and wouldn’t need a cholesterol lowering medicine,” says Dr. Guerci.

“This is a good example of the most constructive role that the heart CAT scan plays, that is actually identifying people who may turn out to have normal coronary arteries, and keeping them out of the cardiac catheterization laboratory,” adds Dr. Reichek.

It appears that there’s a clear role for heart CAT scans, and they are being recognized as a major advancement in cardiac imaging that has a place in the lives of millions of Americans.

http://hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof.(2)

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