Risk assessment in coronary artery disease: Current evidence for use of electron beam computed tomography

Screening is the search for disease in an asymptomatic population. To be used on a widespread basis, screening techniques must be accurate, fast, and inexpensive. This paper summarizes the current data on the use of electron beam computed tomography (EBCT) in screening for coronary artery disease. EBCT allows radiologic quantification of coronary calcium. It can accurately identify coronary calcium, requires 10-15 minutes, and generally costs approximately $500 per study (after an initial high cost for the equipment). Studies in selected asymptomatic populations have suggested that coronary calcium can help to predict cardiac events. It is not yet established that this technique offers incremental risk assessment information in standard office-based evaluation of risk according to the Framingham risk score. Currently, a large, federally funded study, the Multi-Ethnic Study of Atherosclerosis, is being conducted to answer this question. This paper summarizes the current data and diagnostic accuracy of coronary calcium, as measured by EBCT, in the detection of coronary artery disease.