The faster, cheaper way to predict a heart attack

I am a big fan of coronary artery calcium (CAC) score testing, in the right patients, of course.

In my practice, I use it pretty much exclusively to decide if my patients with high cholesterol really need to be taking statin meds or not. It goes without saying that most don’t. But this test quickly identifies exceptions to the rule. (And yes, even I will admit that there are exceptions, albeit rare.)

So, what is a CAC score and what does it tell you? Well, in the plainest terms, it tells you the amount of atherosclerotic plaque in your arteries. Calcification is the process by which this plaque is formed, so detectable levels of calcium are about as straightforward as cardiovascular red flags get.

And, according to one new study, this quick and simple non-invasive test may be the most reliable indicator of heart risk for ER patients with acute chest pain as well.

Now if you’ve ever found yourself in this situation, then you know the testing can get pretty intense. Understandably, ER doctors don’t mess around with chest pain — which lands you on the receiving end of a dozen invasive procedures, from stress tests to cardiac catheterizations.  

So the suggestion that a cheap and easy CAC test — which simply involves a fast CT scan of your chest — may render all other tests unnecessary, is a pretty major finding.

More specifically, this new study asserts that symptomatic patients with a CAC score of zero are unlikely to have obstructive coronary artery disease (CAD), as long as their other risk factors for acute coronary syndrome are also low.    

Among the patients in this particular study, just over half tested at zero CAC. And among the patients with no detectable coronary calcium, fewer than one percent were diagnosed with obstructive CAD (a blockage that narrows the artery by 50 percent or more).

This incidence doubled in patients who smoked and those with type-2 diabetes — but that is to be expected. There’s also the issue of “soft” plaques that haven’t yet calcified going undetected — though this is usually only a concern in younger populations.

But the important takeaway here is that CAC score proved to be better at predicting cardiovascular events and heart disease than stress tests like myocardial perfusion imaging or echocardiography. (Both of which are routine in most hospitals.)

Relying on the CAC test instead will not only save you money, but it will get you in and out of the hospital quicker. (As you may already be aware, typical stress testing involves up to 12 hours of observation — which, in a hospital, doesn’t come cheap.)  

Unfortunately, that’s one big reason you can expect emergency rooms to take their good old time adopting this new screening protocol — assuming they ever do. In case you haven’t noticed, hospitals are not exactly bastions of efficiency in this country.

So my advice to you, as always, is that you ask your primary care doctor to order one of these tests for you. Especially if you have a history of high cholesterol or chest pain. As you may have suspected, these tests are not usually covered by insurance. (At least, not just yet. With more studies like these, there’s hope for the future.)  

But CAC scores are relatively inexpensive to get — usually about $200 or less. It’s good for peace of mind, at the very least. And ultimately, it could save you the trouble and expense of a laundry list of unnecessary stress tests… which, to me, makes them well worth the cost.