Modification of Cardiovascular Risk and Management with MSCT coronary imaging

Acute cardiac death or nonfatal myocardial infarction is the first clinical
manifestation of coronary atherosclerosis in 40-50% of cases. Eighty percent of
coronary artery disease (CAD) mortality in individuals <65 years occurs during
the first heart attack. Moreover, 57% of men and 64% of women who died suddenly
of CAD had no previous symptoms that were typical for the presence of CAD.
Traditional risk factors are used to define the statistical likelihood of
development of an adverse coronary event, but they cannot provide direct
evidence of the presence or degree of coronary atherosclerosis. Accordingly,
traditional riskfactors are not exact predictors of risk and more refined
methods are needed. Knowledge of the presence of atherosclerosis would be most
benificial for this purpose and would allow more appropriate risk
stratification. Since recently, direct visualization of atherosclerosis in a
non-invasive and patient-friendly manner has become possible with MSCT
scanning. Accordingly, the use of MSCT may improve risk stratification by
identification of those patients with and without atherosclerosis. By
determining the various degrees of subclinical atherosclerosis, a more precise
reclassification of high-risk patients into low, medium, high or very high-risk
groups. This reclassification may then allow tailoring of risk management and
improve cost-effectiveness.

To demonstrate whether the use of MSCT in addition to traditional risk
assessment may improve risk stratification in patients presenting without
typical complaints for CAD but an elevated risk profile.

prospective study

Radiation burden
- calcium scan 1.3 to 2.0 mSv
- CT contrast scan 10-15 mSv

Side-effects contrast agent
- a severe side-effect occurs in 0.01% to 0.22% of all examinations.