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Why it's done
By Mayo Clinic staffHeart scans use noninvasive techniques to measure the amount of calcium in the walls of your coronary arteries — the arteries that supply your heart with blood. Having calcium in the walls of your arteries could mean that you have a type of heart disease called coronary artery disease.
Coronary artery disease is a leading cause of heart attacks. Coronary artery disease occurs when plaques build up and narrow your arteries (atherosclerosis). The plaques are made of fat, cholesterol and calcium. It's the calcium in those plaques that the heart scans can detect. Some researchers think the amount of calcium present can be used to calculate a score that, when combined with other health information, helps determine your risk of coronary artery disease or heart attack.
But the use of heart scans has been controversial. Heart scans may not be useful for you if, based on your family history and risk factors, you fall into either a low or high risk category for having a heart attack. The American College of Cardiology and the American Heart Association have created guidelines to determine if a heart scan may be useful in deciding whether you need to take action to prevent a heart attack within three to five years. The guidelines are based on risk factors for coronary artery disease, such as age, sex, cholesterol levels, blood pressure and tobacco use.
A heart scan isn't useful if you have:
- Low heart attack risk. If, for example, you're younger than 55 years old, have normal cholesterol and blood pressure levels and don't smoke, your heart attack risk percentage may be calculated at less than 10 percent, putting you in the low-risk category. It means that because you have few risk factors, you have less than a 10 percent chance of having a heart attack in the next 10 years. So if you're at low risk, a heart scan probably won't tell you anything you and your doctor don't already know.
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High heart attack risk. Having a 20 percent or greater risk of having a heart attack in the next 10 years means you are at high risk. If you have high cholesterol levels and high blood pressure, smoke and are over 65, you'd likely be in this category. If you're at high risk, a heart scan won't do you much good because you and your doctor already know you're at risk based on your risk factors and that you should take steps to prevent a heart attack, such as taking medications or making significant lifestyle changes.
You also shouldn't have a heart scan if you've already had a heart attack or have had a surgical procedure, such as angioplasty or coronary bypass surgery to treat coronary artery disease. In these cases, your doctor will already know you're at a high risk of having a heart attack, and a heart scan won't provide any more information on how your condition should be treated.
When a heart scan might be useful
A heart scan may give you information about your heart attack risk if you fall into the intermediate heart attack risk category. This means, based on your risk factors, your risk of having a heart attack in the next 10 years falls somewhere between 10 percent and 20 percent. For example, you may be considered to have an intermediate heart attack risk if you're between the ages of 55 and 65 years and you have borderline high cholesterol or blood pressure or are a smoker. Your doctor can help you determine what your risk level is. A heart scan may be useful if you're at intermediate risk or if you have chest pain, especially if it's unclear whether a heart problem is the culprit.
- Screening for coronary heart disease: Recommendation statement. U.S. Preventive Services Task Force. http://www.ahrq.gov/clinic/uspstf/uspsacad.htm. Accessed Oct. 7, 2008.
- Budoff MJ, et al. Assessment of coronary artery disease by cardiac computed tomography: A scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation. 2006;114(16):1761-1791.
- Greenland P, et al. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain. Circulation. 2007;115(3):402-426.
- Coronary calcium scan. National Heart Lung and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/cscan/cscan_all.html. Accessed Oct. 7, 2008.
- Detrano R, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. New England Journal of Medicine. 2008;358(13):1336-1345.
- Weintraub WS, et al. Predicting cardiovascular events with coronary calcium scoring. New England Journal of Medicine. 2008;358(13):1394-1396.
- Gerber TC. Diagnostic and prognostic implications of coronary artery calcification detected by computed tomography. http://www.uptodate.com/index. Accessed Oct. 10, 2008.
- Yanowitz FG. Screening for coronary heart disease. http://www.uptodate.com/index. Accessed Oct. 10, 2008.
