Mike Shapiro, DO, MD, FSCCT, director, Center for Prevention of Cardiovascular Disease, and professor of cardiology and molecular medicine at Wake Forest University, Section of Cardiovascular Medicine, discusses the current guidelines for cardiac computed tomography (CT) calcium scoring. He presented on use of CT for coronary artery calcification (CAC) assessment in a session at the 2022 Society of Cardiovascular Computed Tomography (SCCT) conference.
Calcium scoring has become a standard-of-care for evaluating a patient's risk of future heart attacks. The calcium shows past areas that healed after a soft plaque became inflamed and ruptured. The higher the calcium score, the higher the risk of a future cardiac event. Patients with a score of zero have extremely low risk of developing coronary disease. Cardiologists often will use the CAC score to determine if a patient needs to go on statin therapy.
"CT is exquisitely sensitive to the detection of calcified plaque and hence its diagnostic capabilities to detect subclinical atherosclerosis is superb," Shapiro explained. "CAC testing is extremely safe and is associated with very low radiation exposure. It is a robust and reproducible test. Studies of CAC have provided a wealth of prognostic data and the relationship between CAC burden and CV events is consistent amongst every prospective cohort from around the world."
The test uses a low-radiation dose CT scan that does not require contrast. The CT images shows the calcifications in the coronary vessels and software automates the quantification to generate a report.
Many hospitals offer CT calcium scoring exams to patients for a low cost of between $50-$150, because reimbursement is often an issue with the test. However, the low-cost test can provide additional information for determining if a patient needs to go on statins and to quantify their overall heart attack risk over the next decade. Providing a low-cost screening service like this also helps bring in new patients. If a patient is found to have coronary disease, they often will become a life-long cardiology patient for the health system.
"Reimbursement or coronary calcium scoring as a general rule is quite poor, most of the payers are not covering it," Shapiro said. "That is really just a function of the fact that the guidelines do not have it as a Class 1 recommendation, meaning 'you must do this test.'"
To get there, he said more clinic al trial data is needed to show its accuracy in long-term coronary event risk prediction. Shapiro said there are three large trials ongoing, ROBINSCA, CORCAL and the Danish Cardiovascular Screening Trial (DANCAVAS) that are working toward providing that data.
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Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com