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EISNER substudy: Coronary artery calcium scanning fostered effective testing patterns for patients at risk for CVD

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Coronary artery calcification scanning in patients with CVD was associated with substantial differentials in downstream testing and medical costs.

Researchers for the EISNER substudy evaluated the coronary artery calcification scores of 1,361 participants using electron beam and multislice CT. Patients were grouped according to those with coronary artery calcium scores zero to 10 (n=773), 11 to 100 (n=287), 101 to 399 (n=187), 400 to 999 (n=83) and those with 1,000 or greater (n=31). Patients were followed up by questionnaire out to four years, and the primary clinical outcome was the occurrence of CVD death or nonfatal MI.

The researchers reported that 56.7% of patients screened had coronary artery calcium scores <10, with 8.2% having scores>400. The rates of invasive coronary angiography were higher at four years in patients with scores >1,000 vs. those with scores zero to 10 (33.9% vs. 0.8%). Procedural and overall costs increased progressively as coronary artery calcium scores increased (P<.0001 for both). The lowest mean annual procedural costs were associated with coronary artery calcium scores <10 ($177), and the highest procedural costs were associated with patients with a score>1,000 ($4,457). Overall costs were also the lowest in the group with coronary artery calcium scores <10 ($675) vs. those with scores >1,000 ($6,177). Cumulative event-free survival was also higher in patients with the lowest scores (HR=4.03; 95% CI, 1.15-14.13) compared with those with the highest scores (HR=27.93; 95% CI, 6.37-122.56).

“Coronary artery calcium scanning was initially introduced into medical practice solely as a screening test for CAD, but the observation that this test also helps predict the likelihood of inducible myocardial ischemia means that the test may not only serve as a means for detecting latent CAD but also as a potential gatekeeper for determining the need for subsequent medical testing and invasive procedures that may follow among [patients] with suspected CAD,” the researchers concluded. “The findings of our study suggest that coronary artery calcium may play an important role in fostering more efficient, selective testing patterns in asymptomatic individuals at risk for CVD.”

Shaw LJ. J Am Coll Cardiol. 2009;54:1258-1267.