5 Pearls on Calcium Scores and Coronary CTAs
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.
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- 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
- 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.
- 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
- 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.
- 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.
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
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
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.