Comments on: The Absence of Coronary Calcification Does Not Exclude Obstructive Coronary Artery Disease or the Need for Revascularization in Patients Referred for Conventional Coronary Angiography http://www.thepreparedminds.com/archives/1166 In the field of observation, chance favors the prepared minds. Sat, 04 Feb 2012 14:45:45 +0000 hourly 1 http://wordpress.org/?v=3.3 By: Jacobo Kirsch, MD http://www.thepreparedminds.com/archives/1166/comment-page-1#comment-997 Jacobo Kirsch, MD Tue, 09 Feb 2010 14:08:04 +0000 http://www.thepreparedminds.com/?p=1166#comment-997 This study concentrates on symptomatic patients scheduled to undergo clinically indicated conventional angiography, and that should be the take-home point from the study. It is not reasonable to transfer this knowledge to other groups and further studies with mixed-risk populations are warranted. In the meantime, rather than using CCS as a tool to exclude CAD in symptomatic patients, it's capacity to detect the presence CAD in low and intermediate risk patients continues to have clinical value. This study concentrates on symptomatic patients scheduled to undergo clinically indicated conventional angiography, and that should be the take-home point from the study. It is not reasonable to transfer this knowledge to other groups and further studies with mixed-risk populations are warranted.
In the meantime, rather than using CCS as a tool to exclude CAD in symptomatic patients, it’s capacity to detect the presence CAD in low and intermediate risk patients continues to have clinical value.

]]> By: Ronen Rubinshtein, MD http://www.thepreparedminds.com/archives/1166/comment-page-1#comment-993 Ronen Rubinshtein, MD Tue, 09 Feb 2010 09:38:33 +0000 http://www.thepreparedminds.com/?p=1166#comment-993 Also see: Zero or Low Agatston Calcium Score Does Not Exclude Significant Coronary Stenosis in Symptomatic Patients Undergoing 64-Slice Cardiac Computed Tomography. Ronen Rubinshtein; David A Halon; Tamar Gaspar; Jorge E Schliamser; Jacob Goldstein; Basheer Karkabi; Moshe Y Flugelman; Nathan Peled; Basil S Lewis. Am J Cardiol 2007;99:472-5. Abstract <a href="http://circ.ahajournals.org/cgi/content/meeting_abstract/114/18_MeetingAbstracts/II_818-b" rel="nofollow">3824</a> Not all plaques are calcified. Theoretically, calcified lesions are "not new". However, our ability to differentiate acute from chronic symptoms is limited. (e.g. many healthy subjects or "stable patients" in the PEACE trial had elevated level of sensitive cardiac Troponins which was in association with outcome A Sensitive Cardiac Troponin T Assay in Stable Coronary Artery Disease Torbjørn Omland, M.D., Ph.D., M.P.H., James A. de Lemos, M.D., Marc S. Sabatine, M.D., M.P.H., Costas A. Christophi, Ph.D., Madeline Murguia Rice, Ph.D., Kathleen A. Jablonski, Ph.D., Solve Tjora, M.D., Michael J. Domanski, M.D., Bernard J. Gersh, M.B., Ch.B., D.Phil., Jean L. Rouleau, M.D., Marc A. Pfeffer, M.D., Ph.D., Eugene Braunwald, M.D., N Eng J Med 2009; <a href="http://content.nejm.org/cgi/content/short/361/26/2538" rel="nofollow">361:2538-47.</a> Also see:
Zero or Low Agatston Calcium Score Does Not Exclude Significant Coronary Stenosis in Symptomatic Patients Undergoing 64-Slice Cardiac Computed Tomography.
Ronen Rubinshtein; David A Halon; Tamar Gaspar; Jorge E Schliamser; Jacob Goldstein; Basheer Karkabi; Moshe Y Flugelman; Nathan Peled; Basil S Lewis.
Am J Cardiol 2007;99:472-5.
Abstract 3824

Not all plaques are calcified. Theoretically, calcified lesions are “not new”.
However, our ability to differentiate acute from chronic symptoms is limited. (e.g. many healthy subjects or “stable patients” in the PEACE trial had elevated level of sensitive cardiac Troponins which was in association with outcome

A Sensitive Cardiac Troponin T Assay in Stable Coronary Artery Disease
Torbjørn Omland, M.D., Ph.D., M.P.H., James A. de Lemos, M.D., Marc S. Sabatine, M.D., M.P.H., Costas A. Christophi, Ph.D., Madeline Murguia Rice, Ph.D., Kathleen A. Jablonski, Ph.D., Solve Tjora, M.D., Michael J. Domanski, M.D., Bernard J. Gersh, M.B., Ch.B., D.Phil., Jean L. Rouleau, M.D., Marc A. Pfeffer, M.D., Ph.D., Eugene Braunwald, M.D.,
N Eng J Med 2009; 361:2538-47.

]]> By: Paul Schoenhagen, MD http://www.thepreparedminds.com/archives/1166/comment-page-1#comment-989 Paul Schoenhagen, MD Tue, 09 Feb 2010 04:40:18 +0000 http://www.thepreparedminds.com/?p=1166#comment-989 Check comments at: <a href="http://www.theheart.org/article/1046039.do" rel="nofollow">Zero means nothing: "Gatekeeper" role of calcium scoring questioned </a> Reed Miller HeartWire; February 8, 2010 Check comments at:
Zero means nothing: “Gatekeeper” role of calcium scoring questioned
Reed Miller
HeartWire; February 8, 2010

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