Modesti, Pietro Amedeo

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IEditorialiCoronary artery calcium and the risk of infarction: a method in search for a role?Pietro Amedeo Modestident on a demonstration of how much a reduction in cal-cium translates into a reduction in clinical events. With an eye to clinical applications, it should be notedthat the amount of radiation absorbed by a patient duringmeasurement of coronary calcium by multidetector rowcomputed tomography is about 1.5-5.2 mSv in men and1.8-6.2 mSv in women, whereas the correspondingamounts during coronary artery angiography are 2.1 and2.5 mSv2. The highest doses are absorbed during angiog-raphy performed with multidetector row computed tomog-raphy: 6.7-10.9 mSv for men and 8.1-13.0 mSv forwomen2. According to the studies available, this methodadds little information for patients who can already be strat-ified as being at high or low risk of future coronary eventson the basis of clinical and traditional factors, although itmay be of aid in indicating the aggressiveness of strate-gies needed in patients classified as having an intermedi-ate risk (10-20% risk of events at 10 years). Here again,the key factor remains the demonstration of inducibleischemia, because a high calcium score does not necessar-ily indicate the presence of significant stenoses in an indi-vidual patient and cannot, alone, be used as an indicationfor an angiographic examination3. References01. Ratti C, Chiurlia E, Menozzi M, Barbieri A, Modena MG. Il cal-cio coronarico come marker precoce di aterosclerosi. Ann ItalMed Int 2005; 20: 137-42.02. Hunold P, Vogt FM, Schmermund A, et al. Radiation exposureduring cardiac CT: effective doses at multi-detector row CT andelectron-beam CT. Radiology 2003; 226: 145-52. 03. Lau GT, Ridley LJ, Schieb MC, et al. Coronary artery stenoses:detection with calcium scoring, CT angiography, and bothmethods combined. Radiology 2005; 235: 415-22.Dipartimento di Area Critica Medico-Chirurgica (Direttore: Prof.Giulio Masotti), Università degli Studi di Firenze © 2005 CEPI Srl(Ann Ital Med Int 2005; 20: I)Ischemic heart disease is the leading cause of death inwestern countries and research on effective strategies toprevent this disease and to identify subjects at risk at anearly stage are priorities for the health care system. Thereview by Ratti et al.1 published in this issue of the Journalpresents the current evidence on the feasibility of usingcoronary artery calcification, measured by multislice axialcomputed tomography, as a screening instrument and topredict the risk of coronary atherosclerosis. The latestgeneration multislice spiral computed tomography instru-ments are able to carry out an entire scan during the briefperiod a patient holds his breath, allowing high resolutionimages of the heart to be obtained with minimal movementartefacts. This method is becoming used in cardiology notonly for measuring calcium deposition, but also for mon-itoring patients undergoing revascularization procedures(after stent implantation or a bypass) and for studying thewalls and chambers of the heart. As far as the measurement of calcium deposits is con-cerned, autopsy and angiographic data have shown that thecoronary artery calcification score is strongly linked to theextent of atherosclerosis. The calcium score can, therefore,be considered an overall marker of the spread of atheroscle-rosis, useful for identifying those subjects among the gen-eral population who are at risk of future events or forevaluating the progression of disease over time in a givenindividual. The score has also been proposed as a surro-gate marker for evaluating the efficacy of medical treat-ments of atherosclerosis, although this use remains depen-

Coronary artery calcium and the risk of infarction: a method in search for a role?

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Coronary artery calcium and the risk of infarction: a method in search for a role?

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