Non-invasive screening for coronary artery disease: calcium scoring

Despite the decrease in overall mortality from coronary artery disease, the number of out-of-hospital deaths from myocardial infarction is in the range of 60% of all infarct related case fatalities. 1 In patients with known risk of sudden cardiac death (SCD), such as survived resuscitation, left ventricular aneurysm or low left ventricular ejection fraction, the incidence of SCD is in the region of 30% per year. The most widely used algorithm is based on the Framingham study and is incorporated into the NCEP ATP III. 6 Recently, an update was provided which used four categories of 10 year absolute event risk. 7 I. High risk: >20% 10 year risk for hard cardiac events (cardiac death or non-fatal myocardial infarction) resulting from CHD (history of myocardial infarction, unstable angina, stable angina, coronary artery revascularisation) or from cardiac risk equivalents (peripheral artery disease, aortic aneurysms, carotid artery disease (transient ischaemic attacks, stroke or >50% carotid stenosis)) or diabetes or [= or >, slanted]2 major risk factors (smoking, hypertension, hypercholesterolaemia, low high density lipoprotein (HDL cholesterol