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5 Pearls on Calcium Scores and Coronary CTAs

STEP 1: Listen to the podcast

STEP 2 (Members Only): Take the CME/MOC Quiz

Solidify 5 applicable, relevant pearls on an Internal Medicine topic! Dr. Shreya P. Trivedi and Dr. Marty Fried incorporate active learning strategies, such as pre-podcast quizzing, purposeful pauses as well as intentional repetition. The last pearl of some of the podcasts will review a take away from a prior podcast for spaced repetition. 

Show Notes

Pearl 1

  • Coronary CT is an evolving anatomical imaging modality that includes coronary calcium scoring and coronary computed tomography angiogram (CTA).
    • In terms of information for  risk stratification for coronary artery disease, anatomical tests provide information about plaque burden but does not reveal the physiological consequence of the atherosclerosis

Pearl 2

  • Coronary calcium scoring should only be used to risk-stratify asymptomatic patients if the results may influence the initiation of primary prevention medications. 
    • Power of a calcium score of zero: statins are not associated with a reduction in major adverse events in this group and can consider discontinuing a statin. 

Pearl 3

  • Coronary CTA is simply a gated arterial phase contrast CT study that allows us to visualize the coronary arteries.
  • We have randomized trial data that not only are these non-inferior to functional stress testing, but there is the potential to reduce death and non-fatal MI using coronary CTAs over standard care.  
    • Patients undergoing coronary CTA as opposed to functional stress testing are more likely to be initiated on preventative, mortality-reducing therapies. 
  • Added benefits to coronary CT:
    • Detect atherosclerotic disease that wouldn’t get picked up on with either stress test or even a catheterization because it’s also not encroaching on the lumen
    • Coronary CTA also picks up plaque morphology, such as with thin-cap fibroatheroma or “soft plaques”
  • Coronary CTA can identify plaque which might be undetected by coronary angiogram

Pearl 4

  • Avoid coronary CTA in patients with elevated or irregular rates, frequent ectopy, or a history of prior stents. Also, it is generally a poor choice in the elderly or obese.  

Pearl 5

  • Coronary CTAs have a high negative predictive value and therefore, a CCTA without plaque burden can give reassurance that a patient’s symptoms are not from a cardiac source.
  • Coronary CTAs with obstructive coronary lesions (classically thought of as >70% occlusion, >50% occlusion of LAD), the decision should be made on a case-by-case basis with the cardiologist regarding revascularization and/or optimizing medical therapy.

Disclosures

Contributors

Shreya P. Trivedi, MD - Host, Editor, CME questions

Marty Fried, MD -  Co-Host

Evan Harmon, MD - Co-Host

*Pamela Douglas, MD - Guest

Greg Katz, MD - Guest

Aeshita Diwedi, MD - Guest

Reviewers

Matthew Vorsanger, MD

Robert Donnino, MD

Those named above unless otherwise indicated have no relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients.

* Pamela Douglas, MD, disclosed research grants/contracts from Abbott, Akros, HeartFlow, Kowa, Singulex, Verily Life Sciences; honoraria from UptoDate/Kluwer; and consultantship from Bay Labs.

Release Date:  July 10, 2019

Expiration Date: July 10, 2022

CME Credit

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American College of Physicians and Core IM.  The American College of Physicians is accredited by the ACCME to provide continuing medical education for physicians.

The American College of Physicians designates each enduring material (podcast) for 1 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABIM Maintenance of Certification (MOC) Points

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1 medical knowledge MOC Point in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program.  Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

How to Claim CME Credit and MOC Points

After listening to the podcast, complete a brief multiple-choice question quiz.  To claim CME credit and MOC points you must achieve a minimum passing score of 66%.  You may take the quiz multiple times to achieve a passing score.

About Core IM

Welcome to Core IM, a virtual medical community! Core IM strives to empower its colleagues of all levels and backgrounds with clinically applicable information as well as inspire curiosity and critical thinking. Core IM promotes its mission through podcasts and other multimodal dialogues. ACP has teamed up with Core IM to offer continuing medical education, available exclusively to ACP members by completing the CME/MOC quiz.


Details

CME/MOC:

Up to 1 AMA PRA Category 1 Credits ™ and MOC Points
Expires July 10, 2022   active

Cost:

Free to Members

Format:

Podcast

Product:

Core IM