Our approach to CT calcium score

March 26, 2022 Andrew To

MESA calculator - probability of non-zero calcium score

In primary prevention, CT calcium scoring has been suggested to help decision making surrounding statin use.

Some of the underlying concepts are somewhat complex, but the screening paradigm remains that of matching the intensity of preventive efforts with the individual’s absolute risk.

The appropriateness of CT calcium scoring in an individual patient therefore depends

patient’s pretest probability of atherosclerotic cardiovascular risk
potential benefits of preventive therapies
negative aspects and risks of preventive therapies
patient preference

Individual risk assessment - a common scenario

September 4, 2016 Andrew To

1906 San Francisco Fire Sacramento Street; Photo from Arnold Genthe from the Library of Congress

A 40-year-old Maori man came for routine review concerned because his 38-year-old brother, who was a smoker, died suddenly of a heart attack. The patient was athletic, previously played professional rugby, without clinical risk factors.

- BMI 28

- LDL 4.9; TC/HDL ratio 4

His calculated cardiovascular risk on these parameters was low. A reasonable approach would include

1) reinforcing healthy living and reassessing in 5 years

2) reinforcing healthy lifestyle and starting a statin

3) reinforcing healthy lifestyle, getting a CTCA, starting a statin

4) all of the above

CT coronary angiography - Cases

March 6, 2016 Andrew To

Curved reconstruction in CT coronary angiography

A 45-year-old man with no prior cardiac history, but with cardiovascular risk factors including a 10-pack-year smoking history stopped last year, 5-year history of Type II diabetes on Metformin, obesity with BMI of 37, without a family history of premature coronary artery disease, now presented with exertional but inconsistent central chest tightness.

He was investigated extensively, including a negative exercise tolerance ECG at 13 minutes without symptom or ECG change. Despite reassurance, his chest pain continued at random, and has not resolved with a course of Omeprazole for presumed non-cardiac (possibly gastrointestinal reflux) chest pain.

What should we do?

- Reassure him that this pain is almost certainly non-cardiac

- Perform a stress echocardiogram as it has a higher sensitivity than an exercise ECG

- Perform an invasive angiography

CT coronary angiography - How good is it?

March 6, 2016 Andrew To

CT coronary angiography - volume rendered image of the left anterior descending artery and its branches

CT coronary angiography has now been routinely performed, at least in the Waitemata area since 2011, where we were the first to implement CTCA in the workup of acute chest pain in New Zealand.