EBT and Coronary Artery CalciumEBT and Coronary Artery Calcium

Coronary Artery Calcium Coronary Artery Calcium ISIS Atherosclerosis Atherosclerosis

There are There are NONO false positive calcium measures false positive calcium measures by EBT [i.e. ALL calcium is plaque]by EBT [i.e. ALL calcium is plaque]

Establishes a diagnosis ofEstablishes a diagnosis of

coronary atherosclerosiscoronary atherosclerosis

Coronary Calcium Area by EBT andCoronary Calcium Area by EBT andCoronary Artery Plaque AreaCoronary Artery Plaque Area

0

2

4

6

8

10

12

14

16

0 2 4 6 8Square Root Sum of Calcium Areas

Squa

re R

oot S

um o

f Pl

aque

Are

as

Rumberger, Circ 1995:92:2157-62

n = 38n = 38r = 0.90r = 0.90p < .001p < .001

No. of coronary segments/pt. with plaques (IVUS)0 1 2 3 4 5 6 7

No. of calcified coronary

segments/pt. (EBCT)

0

1

2

3

4

5

6

7Y = -0.67 + (0.90 * X)r = 0.86p < 0.0001 N = 40 patientstotal of 222 coronary segments examined

Acute Coronary Syndrome and Non-Obstructive CADAcute Coronary Syndrome and Non-Obstructive CAD# of segments with EBT calcium vs. # of segments with any plaque# of segments with EBT calcium vs. # of segments with any plaque

Schmermund et alSchmermund et alAJC 1998; 81:AJC 1998; 81:141-146141-146

EBT and Coronary Artery CalciumEBT and Coronary Artery Calcium

Define the extent of disease? YESDefine the extent of disease? YES

The amount of calcium The amount of calcium correlates DIRECTLYcorrelates DIRECTLY to to

the amount of measurable coronary disease by:the amount of measurable coronary disease by:

1) direct histopathologic comparison1) direct histopathologic comparison

2) with intravascular ultrasound2) with intravascular ultrasound

Electron Beam TomographyElectron Beam Tomography

Hn x-factor(Agatston Scoring)

130-199 1

200-299 2

300-399 3

>400 4

Area = 15 mmArea = 15 mm22

Volume = 12 mmVolume = 12 mm33 x10 x10-3-3

Agatston (area) ScoreAgatston (area) Scorevs. Volume Scorevs. Volume Score

Area = 8 mmArea = 8 mm22

Volume = 6 mmVolume = 6 mm33 x10 x10-3-3

Agatston (area) ScoreAgatston (area) Scorevs. Volume Scorevs. Volume Score

Total Score = Total Score =

““Risk” of MI, SCD or Ischemia:Risk” of MI, SCD or Ischemia:initially asymptomatic adultsinitially asymptomatic adults

2.7

6.9

14.3

19.7 20.2

0

5

10

15

20

25

30

'1-49 >50 >80 >160 >600

Arad: JACC 2000;36:1253-60

EBCT Calcium ScoreEBCT Calcium Score

Agatston: Circ 1997

Odd

s Rat

ioO

dds R

atio

3-6 yr. f/u3-6 yr. f/un = 367n = 367

3.5 yr. f/u3.5 yr. f/un = 1177n = 1177