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Coronary Calcium Scoring: The Most Advanced Screening Method to Determine Risk of Heart Disease with Coronary CT Scan

The coronary arteries are the vessels that supply oxygen-rich blood to the heart. Plaque – made of fat, calcium, and other substances – can build up and narrow or close the arteries. Plaque or calcium build-up in the coronary arteries causes heart disease and can lead to a heart attack.

To detect this build-up, your physician may order coronary calcium scoring – a test that is also known as coronary artery calcium (CAC) scoring, a heart scan, or calcium score.

Calcium scoring is a non-invasive CT scan (computed tomography) of the heart to calculate your risk of developing coronary artery disease (CAD) by measuring the amount of calcified plaque in the coronary arteries. It is a quick and painless test that is performed by a Starling CT technologist with the assistance of a radiologist.

The coronary calcium scan is a better predictor of coronary events than cholesterol screening or other risk factor assessments. Your primary care provider can advise you if you are a good candidate.

The coronary calcium score is fast, non-invasive, and inexpensive. The out-of-pocket cost is only $99. Talk to your primary care doctor about whether you are a good candidate for coronary calcium scoring.

What To Know About Coronary Calcium Scoring

Computed tomography, more commonly known as a CT or CAT scan, is a diagnostic medical test that, like traditional x-rays, produces multiple images or pictures of the inside of the body.

The cross-sectional images generated during a CT scan can be reformatted in multiple planes and can even generate three-dimensional images. These images can be viewed on a computer monitor, printed on film or by a 3D printer, or transferred to a CD or DVD.

CT images of internal organs, bones, soft tissue, and blood vessels provide greater detail than traditional x-rays, particularly of soft tissues and blood vessels.

A CT scan for coronary calcium is a non-invasive way of obtaining information about the presence, location, and extent of calcified plaque in the coronary arteries – the vessels that supply oxygen-containing blood to the heart muscle. Calcified plaque results when there is a build-up of fat and other substances under the inner layer of the artery. This material can calcify, which signals the presence of atherosclerosis, a disease of the vessel wall, also called coronary artery disease (CAD). People with this disease have an increased risk for heart attacks. In addition, over time, progression of plaque build-up (CAD) can narrow the arteries or even close off blood flow to the heart. The result may be chest pain, sometimes called “angina,” or a heart attack.

Because calcium is a marker of CAD, the amount of calcium detected on a coronary CT scan is a helpful prognostic tool. The findings on CT are expressed as a calcium score. Another name for this test is coronary artery calcium scoring.

The coronary calcium score is the only non-invasive test that can accurately detect – or rule out – the presence of heart disease in otherwise healthy individuals.

The coronary calcium score is the new standard for stratifying cardiac risk. Its superiority to other risk assessment methods, like cholesterol and blood pressure screening, has been demonstrated in numerous clinical studies encompassing more than 20,000 patient years of observation. Additionally, the Society for Heart Attack Prevention and Education (SHAPE) and other supporters recommend this test because:

  • It has been shown to be five (5) times more accurate than other risk assessment methods at predicting which patients are at risk for coronary artery disease
  • Information gained from the calcium score can more accurately identify patients requiring cholesterol-lowering therapy, helping to reduce instances of unnecessary, costly medication

A calcium score (sometimes called an Agatston score) is calculated based on the amount of plaque observed in the CT scan. It may be converted to a percentile rank based on your age and gender. The results from your coronary calcium scoring will be sent to your doctor.

Your likelihood of having heart disease or a heart attack correlates with your calcium scoring. The lower your calcium score and percentile rank, the less likely you are to have a cardiac event compared to other men or women your age.

The purpose of the test is to understand your risk of heart attack or disease, and to take preventive or corrective measures based on these results.

If you have any plaque present (a score greater than 0), your doctor may make recommendations for lifestyle changes, such as quitting smoking, eating better, and exercising more. The higher your score, the more treatment your doctor may recommend. If you have a high score, you can make an appointment with a Starling cardiologist, all of whom are experts at treating coronary artery disease.

Below is how the scoring works:

Zero: No plaque. Your risk of heart attack is low.

1-10: Small amount of plaque. You have less than a 10 percent chance of having heart disease, and your risk of heart attack is low.

11-100: Some plaque. You have mild heart disease and a moderate chance of heart attack. Your doctor may recommend other treatment(s) in addition to lifestyle changes.

101-400: Moderate amount of plaque. You have heart disease and plaque may be blocking an artery. Your chance of having a heart attack is moderate to high. Your health professional may want more tests and may start treatment.

Over 400: Large amount of plaque. You have more than a 90 percent chance that plaque is blocking one of your arteries. Your chance of heart attack is high. Your health professional will want more tests and will start treatment.

At Starling, because this test emits a low dose of radiation, a written referral from your doctor is required. Once referred, you or your provider can call this number to schedule the screening: (860) 224-6222. Screenings are conducted at 300 Kensington Avenue in New Britain.

The procedure is performed by a CT technologist with the assistance of a radiologist.

Once you arrive, you may have to change into a gown if there is any metal on your clothing. The technologist will explain the procedure to you and escort you to the CT room.

You will lie on your back on the CT table and EKG electrodes will be placed on your chest to monitor your heart rate. The CT table will move in very small increments every few seconds and take pictures.

You may be asked to hold your breath for 20 to 30 seconds, and you will need to hold perfectly still. Even though you will be left alone in the room, the technologist will watch you through a window, and you will be able to speak to him or her.

The scan takes approximately 20-30 seconds, but from start to finish it takes approximately 10-15 minutes.

A coronary calcium scan is a very safe procedure; however, it does involve radiation and should be used only when it can provide valuable information about heart attack risk. It requires significantly less radiation than a coronary angiogram or a nuclear stress test.

Because a coronary calcium scan uses radiation, it is not recommended during pregnancy. Please be sure to notify your physician if you are, or may be, pregnant. Also, if you have undergone many tests or procedures that involve radiation in the past, please inform your physician.

The results will be sent to your Starling primary care provider. He or she will assess your calcium score and determine whether:

  • No further action is needed
  • Lifestyle changes may be beneficial
  • Additional tests are needed
  • Medications are required
  • A consult to a cardiologist is needed

No special preparation is necessary in advance of a cardiac CT examination. You should continue to take your usual medications but should avoid caffeine and smoking for four hours prior to the exam.

You should wear comfortable, loose-fitting clothing to your exam. You may be given a gown to wear during the procedure.

Metal objects, including jewelry, eyeglasses, dentures, and hairpins may affect the CT images and should be left at home or removed prior to your exam. You may also be asked to remove hearing aids and removable dental work. Women will be asked to remove bras containing metal underwire. You may be asked to remove any piercings, if possible.

Women should always inform their physician and the CT technologist if there is any possibility that they may be pregnant.

The out-of-pocket cost is only $99. That is a small price to pay for peace of mind about the likelihood of a heart attack.

Talk to your primary care provider today about whether Coronary Calcium Scoring is right for you!  

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