What is the nature of the Coronary Scan?It is an Electron Beam CAT (computed axial tomography) scan of the coronary arteries (the vessels which bring blood and oxygen to the heart muscle). The purpose is to detect and measure coronary calcification, which is the marker for atherosclerosis (the accumulation of plaque within your coronary arteries). The test is non-invasive - no needles, no dyes, no injections. You simply lie on a table, hold your breath and the scanner takes a series of pictures of your heart. The entire process takes only a few minutes. When was this test developed?In the mid-1980s, but it was only in the early 1990s, after years of rigorous testing at major medical centers around the world and publication of papers in major medical journals, that it began being offered to the general public. Is atherosclerosis the same as Coronary Artery Disease?When we talk about either atherosclerosis or Coronary Artery Disease, we're speaking of the same disease process - the accumulation of plaque within the coronary arteries. Many cardiologists however make the distinction that Coronary Artery Disease occurs when atherosclerosis has advanced so far that it has affected coronary blood flow and/or the function of your heart. Don't most people have calcification of their arteries as they grow older?Yes they do, but it is typically people who have large amounts of calcium who are most likely to develop a problem. And, since CASC not only detects, but also measures the extent of coronary calcification, it can identify those individuals who are at greatest risk. Furthermore, there are many people in their 30s, 40s, 50s, 60s and even 70s who have no coronary calcium whatsoever. This test is particularly reliable in identifying these individuals who then can have peace of mind knowing they have a very low probability of having Coronary Artery Disease. Will it tell me how much blockage there is in my coronary arteries?No. This can only be done by an angiogram, which is a highly invasive and expensive procedure. The CASC measures coronary disease in a different way, and a way in which many physicians now believe is more important than the percentage of blockage (also referred to as stenosis or occlusion). The CASC measures the amount of calcified plaque within your coronary arteries. This measurement is highly correlated with your overall level of atherosclerosis, i.e., the more calcium you have, the more plaque you have. And, the more plaque you have, the greater the likelihood you will suffer an event (heart attack or need for surgery) in the future. Your advertising says this test can detect the heart disease process years earlier than any other test. Please explain.Most other tests in cardiology, such as stress cardiograms (also known as treadmill tests) or thallium stress tests or echocardiograms, are testing heart function, and therefore can only reliably detect disease when the disease process is so far advanced that it's already impairing the function of your heart. The CASC, on the other hand, is looking at coronary anatomy and not function. This provides an opportunity to detect and measure plaque accumulation from the point at which the very first speck of calcium is deposited in your arteries. Typically, this is many, many years before cardiac function might ever be affected. How accurate is the test?Numerous studies have shown that CASC is highly reliable in ruling out obstructive Coronary Artery Disease. This means that if you test negative and are without symptoms, there is only a very small chance that you have Coronary Artery Disease. In addition, a June 1, 1996 press release from the American Heart Association stated that "Ultrafast CT scanning with an electron beam proved many times more powerful than the best available non-invasive test in predicting heart attacks and other coronary disease episodes, even in apparently healthy people." Are there other types of heart disease besides Coronary Artery Disease?Yes, but Coronary Artery Disease is the leading cause of death in America today, and it is responsible for the very large majority of all heart attacks. Is this test better than a stress test?We tend not to think in terms of better or worse. Each test in cardiology serves a specific purpose. The proper question to ask is what test is the most appropriate for you. CASC is a screening test, and typically is performed before any of the other cardiac tests, including a stress test. If your scan is negative (normal), then in most cases, it will be unnecessary for you to take any further heart tests. What if I've already passed a stress test?This, of course, is very good news. It means that your heart function is normal, even when you are pushed to peak physical exertion. But, we still do not know if your coronary arteries are clean, if you have a moderate amount of plaque, or if you have an amount which may be a hair short of being obstructive. This is the additional information which a CASC can provide to you. Furthermore, it's important to understand that "the majority of patients destined to die suddenly will not have a positive exercise test." This revelation, first published in The New England Journal of Medicine in 1989, runs contrary to popular belief. The general public assumes that heart attacks occur when you have built up a large amount of plaque at one particular point in your coronary arteries (the "98 or 99% blockage" that we hear about so often). In reality, most heart attacks occur when a smaller plaque (very often a non-obstructive plaque, i.e., one which does not impair heart function and therefore would not be detected by a stress test) ruptures and a blood clot forms on top of the ruptured plaque. Since the CASC is measuring all of your calcified plaque, and not merely those which are large enough to affect heart function, it can identify individuals at risk of sudden death heart attack even if they have no symptoms or current impairment of cardiac function. Does it replace a Thallium Test or a PET Scan or an Angiogram?No. The primary use of CASC is as an inexpensive screening procedure for asymptomatic individuals. These other tests are all invasive in nature and much more expensive than this test. CASC is often used to determine if a patient should be subjected to such a procedure. In fact, in a 1994 article which appeared in the journal Radiology, researchers from the National Institutes of Health recommended that CASC be performed in any patient for whom an angiogram is being considered. The reason for this is simple - approximately 25% of all angiograms turn out to be normal. This means there are hundreds of thousands of patients each year in the United States alone with "normal" coronary arteries who are subjected to an expensive, uncomfortable procedure which carries with it the risk (albeit small) of stroke, heart attack or death. In many of these cases, having a CASC first would demonstrate that there is no real need to have an angiogram. What about individuals who have already had a heart attack, coronary angioplasty, bypass surgery, or coronary angiography?This test is generally viewed as being not appropriate for anyone who has already had bypass surgery. However, for those who have had heart attacks, angioplasties or angiograms, it may be useful to provide a benchmark against which we can measure the future progression of disease. Anyone who has had a heart attack or angioplasty should be under the care of a cardiologist and it would be best to consult with such cardiologist to determine if the test will be appropriate for you. It is important to note here that anyone who has had a heart attack, coronary angioplasty or bypass surgery should inform his/her siblings and/or adult children about the availability of this test. As you probably know, there is often a genetic component to heart disease. Accordingly, if you have the disease, this increases the likelihood that your blood relatives have the disease as well. Is there any risk to the patient?The patient is subjected to a small amount of radiation, approximately equivalent to the radiation received during one abdominal x-ray. How are the results presented?The results present, on an artery-by-artery basis, the amount of calcium present. The total amount of calcium (the calcium score) is then compared to the scores of other individuals of your age and gender. In addition, the physician provides a final conclusion and recommendations with respect to your test results. What happens if I am positive, i.e., the test shows I have coronary calcium?In all cases, whether the test result is positive or negative, you are urged to share these results with your personal physician. No test in medicine should be viewed in isolation. Test results are most meaningful when they are placed in the context of your entire medical profile, and typically it is your personal physician who is best able to do this. In general, however, the treatment prescribed by a physician will usually depend upon the extent of calcification detected, the patient's age, general health, symptoms (if any) and presence of controllable risk factors for Coronary Artery Disease. Treatments prescribed may be as simple as modifying these risk factors, including stopping smoking, improving diet, and starting an exercise program. Additional testing and more aggressive treatment, including medication, might also be required. What is the cost of the test?$395 How and when is payment made?At the time of scheduling, you must provide us with a major credit card number to reserve an appointment slot. The card will be charged on the date of service. If you do not have a major credit card, you may mail us a check, but we will not confirm an appointment until the check clears. Do I need a referral from my physician to schedule an appointment?No. The test may be scheduled on a self-referred basis. What about insurance reimbursement?We will furnish you with a bill which you may submit to your insurance company. This bill will be sent to you together with your test results. Whether or not the insurance company provides reimbursement for the test is governed by the specific provisions of your policy. Heart Check America takes no responsibility for nor makes any representations regarding insurance reimbursement from any private insurance carrier. If before scheduling, you wish to check if your insurance carrier will reimburse you for the procedure, we suggest you call your customer service department and inform them that you are planning to undergo a CT scan of the Coronary Arteries, which is identified either as procedure code 71250 or HCPCS code S8092. Having provided this information, they should be able to tell you if the procedure is covered by your plan, at what rate you will be reimbursed, and if there are any special requirements you must meet, e.g., a referral from your primary care physician, in order to obtain reimbursement. What about Medicare, Medicaid or Medi-Cal?At the present time, none of the above pays for this test. |
|
Copyright 2001© |
