Impact of Coronary Artery Calcium Scanning on Coronary Risk Factors and Downstream Testing The EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) Prospective Randomized Trial

OBJECTIVES: We conducted a prospective randomized trial to compare the clinical impact of conventional risk factor modification to that associated with the addition of coronary artery calcium (CAC) scanning.  Although CAC scanning predicts cardiac events, its impact on subsequent medical management and coronary artery disease risk is not known.

METHODS: We assigned 2,137 volunteers to groups that either did undergo CAC scanning or did not undergo CAC scanning before risk factor counseling. The primary end point was 4-year change in coronary artery disease risk factors and Framingham Risk Score. We also compared the groups for differences in downstream medical resource utilization.

RESULTS: Compared with the no-scan group, the scan group showed a net favorable change in systolic blood pressure (p = 0.02), low-density lipoprotein cholesterol (p = 0.04), and waist circumference for those with increased abdominal girth (p = 0.01), and tendency to weight loss among overweight subjects (p = 0.07). While there was a mean rise in Framingham Risk Score (FRS) in the no-scan group, FRS remained static in the scan group (0.7 ± 5.1 vs. 0.002 ± 4.9, p = 0.003). Within the scan group, increasing baseline CAC score was associated with a dose-response improvement in systolic and diastolic blood pressure (p < 0.001), total cholesterol (p < 0.001), low-density lipoprotein cholesterol (p < 0.001), triglycerides (p < 0.001), weight (p < 0.001), and Framingham Risk Score (p = 0.003). Downstream medical testing and costs in the scan group were comparable to those of the no-scan group, balanced by lower and higher resource utilization for subjects with normal CAC scans and CAC scores ≥400, respectively.

CONCLUSIONS: Compared with no scanning, randomization to CAC scanning was associated with superior coronary artery disease risk factor control without increasing downstream medical testing. Further study of CAC scanning, including pre-specified treatment recommendations, to assess its impact of cardiovascular outcomes is warranted.

PMID: 21439754

Posted in Computed Tomography and tagged , , , , .

2 Comments

  1. In my opinion, by far the greatest information to come out of this study is that when patients are aware – visually, not just subjectively – of the presence of plaque in their coronaries they are more willing to act upon improving their lifestyle.

    While many studies focus on the cost-effectiveness of imaging, the psychological aspect can sometimes very helpful as well.

  2. See post from 3/23/2011:

    Quantification of Coronary Atherosclerosis and Inflammation to Predict Coronary Events and All-Cause Mortality.
    Stefan Möhlenkamp, Nils Lehmann, Susanne Moebus, Axel Schmermund, Nico Dragano, Andreas Stang, Johannes Siegrist, Klaus Mann, Karl-Heinz Jöckel, Raimund Erbel Heinz Nixdorf Recall Study Investigators.
    J Am Coll Cardiol. 2011; 57(13):1455-1464.
    PMID: 21435514

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>