Am J Cardiol 2000 Apr 15;85(8):945-8
Prognostic value of coronary electron-beam computed tomography for coronary
heart disease events in asymptomatic populations.
O'Malley PG, Taylor AJ, Jackson JL, Doherty TM, Detrano RC.
The predictive ability of electron-beam computed tomography (EBCT) for coronary
heart disease outcomes, particularly hard coronary outcomes (myocardial
infarction or death), has been questioned in asymptomatic populations. Our
objective was to synthesize data on the use of EBCT for determining
cardiovascular prognosis in asymptomatic populations. Studies were identified
using standard systematic review methods. The outcome of interest was relative
risk for myocardial infarction or sudden death, and combined events including
revascularization. Nine articles met the inclusion criteria, of which 5 were of
independent studies. Using meta-analytic techniques to synthesize prognostic
data, there was an increased risk (summary risk ratio 8.7, 95% confidence
interval 2.7 to 28.1) of a combined outcome of nonfatal myocardial infarction or
death or revascularization if the calcium score was above a median score.
Similarly, there was an increased risk for hard events: myocardial infarction or
death (summary risk ratio 4.2, 95% confidence interval 1.6 to 11.3). However,
there was significant heterogeneity in the studies' quality and patient
populations. Although EBCT appears to predict combined and hard coronary
outcomes similarly in high risk, asymptomatic populations, these results should
be interpreted with caution. Further study is needed on the incremental value of
EBCT over conventional risk prediction before this test is used in screening
asymptomatic populations.
