Chronic stable angina electron beam tomography

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Smita Kohli, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.

Synonyms and keywords: Ultrafast Computed Tomography; EBCT

## Overview

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The extent of coronary artery calcification directly correlates to the area of atheromatous plaque.[1] Hence in patients with chest pain, coronary artery calcium (CAC) scoring is one of the factor to be considered in the risk assessment for coronary artery disease. The methods used for detection and quantification of CAC include electron beam computed tomography (EBCT) and multi-detector computed tomography (MDCT).[2] Agatston score is a computed software that is commonly used to measure CAC based on the density and area of calcified plaques.[3]

## Electron Beam Tomography

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### Indications

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* Ultrafast computed tomography can be used to detect coronary calcifications, which often precede symptomatic coronary artery stenosis. However, coronary calcification is also observed in patients without important coronary artery disease at angiography.

* CT angiography used for the detection of CAD, has a negative predictive value of 93-99%, sensitivity of 90-94% and specificity of 95-97%.[4][5]

* CT angiography is indicated in patients with a low pretest probability of CAD (less than 10%) or in patients with non conclusive exercise ECG or stress test.

* Although this test has generated substantial interest and publicity, the current lack of information from large scale assessments make it premature to recommend its use in routine clinical care.

## ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)[6]

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### Noninvasive Testing-Electron Beam Tomography (DO NOT EDIT)[6]

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Class IIb

"1. Electron beam computed tomography. (Level of Evidence:B)"

## ESC Guidelines- Computed Tomography in Patients with Chronic Stable Angina (DO NOT EDIT)[7]

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Class IIb

"1. Patients with a low pre-test probability of CAD, with a non-conclusive exercise ECG or stress imaging test. (Level of Evidence:C)"

## References

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1. ↑ Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS (1995) Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. Circulation 92 (8):2157-62. PMID: 7554196
2. ↑ Greenland P, Bonow RO, Brundage BH, Budoff MJ, Eisenberg MJ, Grundy SM et al. (2007) ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 49 (3):378-402. DOI:10.1016/j.jacc.2006.10.001 PMID: 17239724
3. ↑ Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15 (4):827-32. PMID: 2407762
4. ↑ Leschka S, Alkadhi H, Plass A, Desbiolles L, Grünenfelder J, Marincek B et al. (2005) Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur Heart J 26 (15):1482-7. DOI:10.1093/eurheartj/ehi261 PMID: 15840624
5. ↑ Raff GL, Gallagher MJ, O'Neill WW, Goldstein JA (2005) Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46 (3):552-7. DOI:10.1016/j.jacc.2005.05.056 PMID: 16053973
6. ↑ 6.0 6.1 Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM; et al. (1999). "ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina)". Circulation. 99 (21): 2829–48. PMID 10351980.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
7. ↑ Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)

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