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Management of Coronary Artery Calcium and Coronary CTA Findings

Coronary artery calcium (CAC) testing and coronary computed tomography angiography (CTA) have significant data supporting their ability to identify coronary artery disease (CAD) and classify patient risk for atherosclerotic cardiovascular disease (ASCVD). Evidence regarding CAC use for screening has...

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Autores principales: Thomas, Dustin M., Divakaran, Sanjay, Villines, Todd C., Nasir, Khurram, Shah, Nishant R., Slim, Ahmad M., Blankstein, Ron, Cheezum, Michael K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412516/
https://www.ncbi.nlm.nih.gov/pubmed/25960825
http://dx.doi.org/10.1007/s12410-015-9334-0
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author Thomas, Dustin M.
Divakaran, Sanjay
Villines, Todd C.
Nasir, Khurram
Shah, Nishant R.
Slim, Ahmad M.
Blankstein, Ron
Cheezum, Michael K.
author_facet Thomas, Dustin M.
Divakaran, Sanjay
Villines, Todd C.
Nasir, Khurram
Shah, Nishant R.
Slim, Ahmad M.
Blankstein, Ron
Cheezum, Michael K.
author_sort Thomas, Dustin M.
collection PubMed
description Coronary artery calcium (CAC) testing and coronary computed tomography angiography (CTA) have significant data supporting their ability to identify coronary artery disease (CAD) and classify patient risk for atherosclerotic cardiovascular disease (ASCVD). Evidence regarding CAC use for screening has established an excellent prognosis in patients with no detectable CAC, and the ability to risk re-classify the majority of asymptomatic patients considered intermediate risk by traditional risk scores. While data regarding the ideal management of CAC findings are limited, evidence supports statin consideration in patients with CAC > 0 and individualized aspirin therapy accounting for CAD risk factors, CAC severity, and factors which increase a patient’s risk of bleeding. In patients with stable or acute symptoms undergoing coronary CTA, a normal CTA predicts excellent prognosis, allowing reassurance and disposition without further testing. When CTA identifies nonobstructive CAD (<50 % stenosis), observational data support consideration of statin use/intensification in patients with extensive plaque (at least four coronary segments involved) and patients with high-risk plaque features. In patients with both nonobstructive and obstructive CAD, multiple studies have now demonstrated an ability of CTA to guide management and improve CAD risk factor control. Still, significant under-treatment of cardiovascular risk factors and high-risk image findings remain, among concerns that CTA may increase invasive angiography and revascularization. To fully realize the impact of atherosclerosis imaging for ASCVD prevention, patient engagement in lifestyle changes and the modification of ASCVD risk factors remain the foundation of care. This review provides an overview of available data and recommendations in the management of CAC and CTA findings.
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spelling pubmed-44125162015-05-06 Management of Coronary Artery Calcium and Coronary CTA Findings Thomas, Dustin M. Divakaran, Sanjay Villines, Todd C. Nasir, Khurram Shah, Nishant R. Slim, Ahmad M. Blankstein, Ron Cheezum, Michael K. Curr Cardiovasc Imaging Rep Cardiac Computed Tomography (TC Villines, Section Editor) Coronary artery calcium (CAC) testing and coronary computed tomography angiography (CTA) have significant data supporting their ability to identify coronary artery disease (CAD) and classify patient risk for atherosclerotic cardiovascular disease (ASCVD). Evidence regarding CAC use for screening has established an excellent prognosis in patients with no detectable CAC, and the ability to risk re-classify the majority of asymptomatic patients considered intermediate risk by traditional risk scores. While data regarding the ideal management of CAC findings are limited, evidence supports statin consideration in patients with CAC > 0 and individualized aspirin therapy accounting for CAD risk factors, CAC severity, and factors which increase a patient’s risk of bleeding. In patients with stable or acute symptoms undergoing coronary CTA, a normal CTA predicts excellent prognosis, allowing reassurance and disposition without further testing. When CTA identifies nonobstructive CAD (<50 % stenosis), observational data support consideration of statin use/intensification in patients with extensive plaque (at least four coronary segments involved) and patients with high-risk plaque features. In patients with both nonobstructive and obstructive CAD, multiple studies have now demonstrated an ability of CTA to guide management and improve CAD risk factor control. Still, significant under-treatment of cardiovascular risk factors and high-risk image findings remain, among concerns that CTA may increase invasive angiography and revascularization. To fully realize the impact of atherosclerosis imaging for ASCVD prevention, patient engagement in lifestyle changes and the modification of ASCVD risk factors remain the foundation of care. This review provides an overview of available data and recommendations in the management of CAC and CTA findings. Springer US 2015-04-15 2015 /pmc/articles/PMC4412516/ /pubmed/25960825 http://dx.doi.org/10.1007/s12410-015-9334-0 Text en © The Author(s) 2015 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Cardiac Computed Tomography (TC Villines, Section Editor)
Thomas, Dustin M.
Divakaran, Sanjay
Villines, Todd C.
Nasir, Khurram
Shah, Nishant R.
Slim, Ahmad M.
Blankstein, Ron
Cheezum, Michael K.
Management of Coronary Artery Calcium and Coronary CTA Findings
title Management of Coronary Artery Calcium and Coronary CTA Findings
title_full Management of Coronary Artery Calcium and Coronary CTA Findings
title_fullStr Management of Coronary Artery Calcium and Coronary CTA Findings
title_full_unstemmed Management of Coronary Artery Calcium and Coronary CTA Findings
title_short Management of Coronary Artery Calcium and Coronary CTA Findings
title_sort management of coronary artery calcium and coronary cta findings
topic Cardiac Computed Tomography (TC Villines, Section Editor)
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412516/
https://www.ncbi.nlm.nih.gov/pubmed/25960825
http://dx.doi.org/10.1007/s12410-015-9334-0
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