The use of electron beam tomography
(EBCT) for the detection
and quantitation of coronary atherosclerotic plaque burden has become
increasingly disseminated and has been accompanied by a corresponding increase
in the scientific literature validating its utility. However, there has not been
a consensus document providing guidelines for its application. The newly formed
Society of Atherosclerosis Imaging, with representation from the imaging and
epidemiologic communities, has undertaken to provide such guidelines. Operating
under the following charter: "To promote and coordinate an integrated
approached to atherosclerosis detection and prevention emphasizing noninvasive
imaging and risk factor modification," the Society of Atherosclerosis
Imaging has developed recommendations that reflect current usage supported by
emerging data. At the same time, considerable leeway is afforded for physician
use according to individual practice patterns. Pending publication of peer
reviewed data supporting other imaging modalities, these guidelines are
currently applicable only to EBCT.
The American College of Cardiology/American Heart Association
classifications, I, II and III are used to summarize indications.
Class 1: Conditions for which there is evidence and/or
general agreement that a given procedure or treatment is useful and
effective.
-
Initial diagnostic test in ambulatory adults <
65 years of age with atypical chest symptoms, in the absence of established
cardiovascular disease.
-
Supplementary diagnostic test in adults < 65
years of age with indeterminate stress test results, in the absence of
established cardiovascular disease.
-
Emergency room evaluation of men < 50 and women
< 60 years of age with chest pain and normal or nondiagnostic
electrocardiograms, in the absence of established cardiovascular disease.
Class II: Conditions for which there is conflicting
evidence and/or a divergence of opinion about the usefulness/or efficacy of a
procedure.
IIa: Weight of evidence/opinion is in favor of
usefulness/efficacy.
-
Mean 45 to 65 years of age, women 55 to 75 years of age
in the absence of established cardiovascular disease; subtract 10 years if
any of the following risk factors are present (thus deemed
"Intermediate Risk"): family history of premature coronary artery
disease (first-degree male relative < 55 years of age and female relative
< 65 years of age); hypertension; smoking (current or within last year);
elevated low-density lipoprotein or reduced high-density lipoprotein based
on current National Cholesterol Education Program guidelines.
-
Diabetic men 35 to 65 years of age and women 35 to 75
years of age without known cardiovascular disease.
-
Assist physicians in decision-making regarding initiation
or change of drug therapy for cholesterol abnormalities in patients without
established cardiovascular disease.
IIb: Usefulness/efficacy is less well established by
evidence/opinion.
-
Monitoring progression and effects of treatment after
interval of ³ 1 year.
-
Evaluating the etiology of heart failure.
-
Following patients after cardiac transplantation.
Class III: Conditions for which there is evident
and/or general agreement that the procedure/treatment is not useful/effective
and in some cases may be harmful.
-
Pregnancy
-
Prior coronary artery bypass surgery or coronary artery
stent placement
-
Established coronary artery disease without plan for
follow up study to track progression/treatment.
Society of Atherosclerosis Imaging: President - Harvey S.
Hecht MD ; Secretary/Treasurer –George P. Rodgers MD ; Director of Medical
Affairs – John A. Rumberger MD, PhD ; Board of Directors – Stephan Achenbach
MD, Arthur A. Agatston MD, Daniel S. Berman MD, B. Greg Brown MD, PhD, Matthew
J. Budoff MD, Tracy Q. Callister MD, William P. Castelli MD, James Ehrlich,MD,
Alan D. Guerci MD, Warren R. Janowitz MD, David King, Lewis H. Kuller MD, DrPH,
Daniel J. Rader MD, Paolo Raggi MD, William C. Roberts MD, Patrick F. Sheedy II
MD, Alan G. Wasserman MD
