During a pain in the chest, a study made it possible to compare the techniques of exploration. And it seems that the calcium score is a very interesting option.
Cardiac imaging examines the heart in great detail. The largest study to date, conducted on more than 8,800 people over 26 months, compared the prognostic value of the calcium score and functional explorations. It was performed in the assessment of the risk of coronary heart disease in people who come to the emergency room with stable chest pain.
A negative calcium score would very simply eliminate coronary disease and cardiovascular risk and thus avoid the unnecessary expense of more expensive functional tests. By the way, this study shows that coronary heart disease is ultimately uncommon in chest pain. This study appeared in the journal Circulation.
Very different tests
The calcium score is a simple and rapid radiological examination, carried out in a few minutes from a chest scanner without injection or perfusion, to assess the extent of calcified deposits (atherosclerosis) in the vessels that supply blood to the heart (the coronaries). , and therefore coronary artery disease. This examination, which does not require any specific preparation or fasting, therefore assesses the cardiovascular risk, even in the absence of any symptoms.
The functional tests pursue the same objective, but by evaluating in addition the repercussions of the obstruction of the coronaries under stress (where the necessary blood flow is read important). They are a bit more complicated to make and more expensive. These are the exercise electrocardiogram, the myocardial scintigraphy and the stress ultrasound.
A disease that has not been very symptomatic for a long time
Coronary artery disease begins with a long period without any signs, the diagnosis can be made very late, at an advanced stage of the disease, or even at the time of the infarction.
Several studies have shown that the higher the calcium score, the greater the cardiovascular risk. When the score is between 100 and 400, for example, it means that there is an onset of coronary atheroma, the cardiovascular risk is high. If it exceeds 400, it means that the atheromatous lesions are multiple and that they can lead to the obstruction of the irrigation of the heart (infarction), the cardiovascular risk is then very high.
Conversely, if the calcium score is negative, it means that there is no coronary atheroma and the cardiovascular risk is very low.
The largest comparative study
The authors of the PROMISE study (prospective multicenter imaging study for the evaluation of pain in the chest, or chest pain), carried out on more than 8,800 people with stable chest pain, compared the prognostic value of the score coronary calcium compared to functional cardiac investigations, that is to say all the functional and non-invasive cardiovascular examinations such as cardiac stress ultrasound, stress test (exercise ECG ) or even myocardial scintigraphy.
The interesting calcium score if it is negative
For 26 months, 4,209 patients were randomized to the “Calcium score” group and 4602 to the “Functional tests” group. The results showed that because of its simplicity of realization, its low cost and the little risk that it presents, the calcium score, when it is negative (Agatston score less than 100), could be a very good way to rule out acute coronary syndrome or cardiovascular risk in people who present to the emergency room with stable chest pain. In the event of a positive score, the functional explorations can then come very legitimately to make a diagnosis.
When faced with pain in the chest, the calcium score can be chosen first because it is quick, simple and well tolerated. If it is negative, it makes it possible to rule out coronary artery disease and directly search for other diseases causing this pain. If it is positive, functional tests can be considered to advance the coronary diagnosis.
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