Probability of coronary artery disease

Medicine is a science of uncertainty and an art of probability -Osler

Atherosclerotic heart disease is the number one cause of death. Ischemic heart disease types Methods of detecting coronary artery disease prior to fatal events are needed so that appropriate measures can be taken to reduce risk. Risk factors of coronary heart disease Anatomic studies have established that coronary calcification is invariably located near areas of advanced atherosclerotic disease. How to reverse heart disease A direct relation between the extent of coronary calcification and the severity of stenotic lesions or frequency of myocardial infarction is consistently observed in autopsy series.

Canine heart disease The more extensive the calcification, the more frequent and more severe the degree of stenosis. Heart disease signs This relationship is recognized in all age groups and both sexes, but is more marked in younger patients.

CT and in particular, electron-beam CT (EBCT) is the most sensitive radiographic method to detect coronary artery calcification. Rheumatic heart disease management The value of EBCT can be summarized as follows:

• Does not absolutely rule out the presence of atherosclerotic plaque, including unstable plaque

• Highly unlikely in the presence of significant luminal obstructive disease

• Observation made in the majority of patients who have had both angiographically normal coronary arteries and EBCT scanning

• May be consistent with a low risk of a cardiovascular event in the next 2-5 years

• The greater the amount of calcification (i.e., calcium area or calcium score), the greater the likelihood of obstructive disease, but there is no one-to-one relation, and findings may not be site specific

• Total amount of calcification correlates best with total amount of atherosclerotic plaque, although the true “plaque burden” is underestimated

• A high calcium score may be consistent with moderate to high risk of a cardiovascular event within the next 2-5 year

• Lesion Score 1 = 130 – 199, 2 = 200 – 299, 3 = 300 – 399, 4 > 400

• Score each region of interest by multiplying the density score and the area

• Total coronary calcium score determined by adding up each lesion score for all sequential slices

Select age, gender, patient presentation, coronary artery calcification at CT

For the prior probability of coronary artery disease, the above model uses age, gender and clinical presentation. Coronary heart disease gcse Other predictive models could be used for prior probability. Left main coronary artery disease Based on data from the Framingham Study, predictive models have been derived from the blood pressure, total cholesterol, LDL cholesterol, and HDL cholesterol, diabetes, smoking, gender and age. Icd 9 valvular heart disease To calculate risk based on these models choose one of the following.

Likelihood ratios for coronary artery calcification and significant coronary artery disease (>70% stenosis) Budoff n=709

From 6 participating centers, EBCT used in 709 patients (427 with angiographic significant disease). Heart disease is Likelihood ratios (95% confidence interval) calculated from data provided in Table 2.

Note that in older subjects, the presence of calcium does not raise the likelihood of significant coronary artery disease as much as it does in younger patients. Heart disease america Conversely note that the absence of calcium markedly decreases the likelihood of coronary artery disease in the older patient population.

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Information provided is not intended to be medical or technical advice. Heart disease research The information given at this site is for educational purposes only and is not sufficient for medical decisions. Diabetes heart disease I disclaim any liability for the acts of any physicians or any other individual who receives any information on any medical procedure through this web site. Degenerative heart disease I accept no legal responsibility for any injury and/or damage to persons or property from any of the suggestions or material discussed herein.

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