Coronary artery stenosis : the role of calcium scoring and coronary angiography.

Abstract

Atherosclerosis is one of the leading diseases, which cause a high mortality and morbidity rate in the industrialized world. Early detection of the stenotic sites in the coronary arteries would mean that this high mortality and morbidity rate would be lessened. When evaluating stenosis, invasive angiography is the gold standard modality which is used to evaluate the presence of atherosclerosis and to treat the patient if needed. Another modality being computed tomography has evolved on a wide scale in these lost few years and has become quite a popular modality for the detection of coronary artery stenosis. When comparing both modalities various advantages and disadvantages of both modalities arise leading to a debatable issue for which of the two modalities should be used in the detection of atherosclerosis. Till the present moment, both issues are dependable on each other, because where one modality weakens, the other gains and vice-versa. Invasive angiography is used on patients with a known level of stenosis, due to its risks and due to the advantage of being able to directly treat the patient if needed. On the other hand CT calcium scoring which is a technique related to computed tomography, is used for routine check ups or opportunistic screening. CT calcium scoring assesses the total score of the amount of calcium present in the coronary arteries, as calcium is an early symptom of atherosclerosis. This is of great use as it can detect stenosis at its early stage, as even the least amount of calcium can be detected. Early detection of a disease can be done by the introduction of mass screening, but various criteria are to be satisfied by the modality to be set as a screening modality. For a modality to fit as o screening modality, the accuracy, treatment availability, and early detection should be fulfilled by the modality while the disease should be of high mortality rate, with known possible changes and life span. At the present moment neither of the two modalities satisfies the screening criteria. The most accurate modality, which in this case is invasive angiography, should be used, while computed tomography needs to increase in accuracy and introduce treatment to its field. With the evolving technologies, modalities with great accuracy like Electron Beam Computed Tomography should be used, while recent techniques like the use of monochromatic X-rays should continue to be studied and researched, as these studies would hopefully make the detection of atherosclerosis at an early stage possible, contributing to the reduction of the mortality rate.