Cardiac Scan Predicts Heart Attack Risk

But expert wonders whether it's any better than a skilled doctor

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By
HealthDay Reporter

(HealthDay is the new name for HealthScoutNews.)

TUESDAY, Aug. 26, 2003 (HealthDayNews) -- New research provides more evidence that a high-tech cardiac scan reliably predicts whether high-risk patients will drop dead of a heart attack within the next five years.

But there's still debate over whether the scan offers much more information than a simple doctor's examination in most cases.

"The question is: How much does this add?" says Dr. Richard C. Pasternak, spokesman for the American Heart Association.

The findings appear in the September issue of the journal Radiology.

The scan technology, known as electron-beam computed tomography, is hardly new. Doctors have been using it for at least 15 years, and the scans have become a common offering at controversial "body scan" centers that sell their services to worried people who think they may have undetected disease.

When trained on the body, the scans measure levels of calcium in the bloodstream, a possible indication that vessels are becoming clogged. Blocked arteries prevent blood from flowing smoothly and can lead to coronary disease and heart attacks.

"If you can show calcium on the scan, it suggests blockages are usually present at least to some degree," says Pasternak, director of preventive cardiology at Massachusetts General Hospital.

In this latest study, Dr. Paolo Raggi, a cardiologist and professor of medicine at the Tulane University School of Medicine, and his colleagues studied more than 10,300 patients from 1996 to 2000. Their ages ranged from 30 to 85 years old, and 40 percent were women. All were at high risk for coronary disease due to factors such as high cholesterol, high blood pressure, smoking or a family history of heart problems.

The patients with the highest levels of calcium in their blood (over 1,000) were 12 times more likely to die of heart disease than those at the lowest level (under 11). Even those with calcium levels of 11 to 100 were almost 2.5 times more likely to die.

While the scans only take about five minutes, they're not cheap. The cost per scan runs from $150 to $450, Raggi says.

So who should get the test? Both Raggi and Pasternak say it isn't right for everyone.

"You couldn't possibly scan the entire nation and do a blanket approach for everyone, unless the test cost $10," Raggi says. "It is obvious that you need to limit the test to those who may benefit the most."

But the scans could help doctors as they evaluate patients who appear to be at moderate risk of heart problems, he says. "Traditional known risk factors tell the story about coronary disease to a point, but they can only predict up to a certain degree who's going to be at risk of having a heart attack."

Pasternak is somewhat less enthusiastic. Calcium scans appear to only be a "little better" at predicting death than simple analysis of risk factors, he says.

Those at highest risk, he adds, should be getting the most treatment regardless of what any scans show.

However, he did say "there are cases where this [the scan] may help in the decision-making process" regarding treatment. "For a clinician who's having great difficulty in deciding whether more aggressive therapy should be used, this [test] presents one opportunity to shade that gray lighter or darker."

More information

Learn more about calcium cardiac scans from The Advanced Medical Technology Association or from a Colorado radiology center that offers the scan.

SOURCES: Richard C. Pasternak, M.D., spokesman, American Heart Association, and director, preventive cardiology, Massachusetts General Hospital, Boston; Paolo Raggi, M.D., professor, medicine, Tulane University School of Medicine, and associate chief, cardiology, Tulane University Hospital and Clinics, New Orleans; September 2003 Radiology

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