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NEW YORK (Reuters Health) – Coronary calcification detected by electron-beam computed tomography (EBCT) may be helpful in distinguishing between syndrome X and coronary artery disease (CAD) in certain patients, according to Taiwanese researchers.
Dr. Jaw-Wen Chen, of Taipei Veterans General Hospital and Cardiovascular Research Center, and colleagues note that use of this technique has rarely been evaluated "especially in aged patients with chronic, stable angina."
To do so, the researchers studied 40 such patients with syndrome X, 53 with CAD, and 10 controls with normal coronary angiographic findings and negative exercise treadmill test results. The mean ages in all groups were greater than 61 years. The findings were published in the November issue of Chest.
Coronary calcification was seen in 20% of controls, 52.5% of the syndrome X patients, and 96.2% of those with CAD. The median coronary calcium score by EBCT was 1 in syndrome X patients and 202 in CAD patients.
Multivariate analysis showed that for CAD patients, whose coronary calcium scores were below 117 and above 5, the significantly higher incidence of hypertension and hypercholesterolemia served as powerful discriminators from syndrome X patients who had coronary calcium scores in the same range.
The researchers thus conclude that in addition to standard cardiovascular risk factors, coronary calcium score determined by EBCT could differentiate these two groups of patients with chronic stable angina with evidence of myocardial ischemia.
In an accompanying editorial, Dr. Alexander Ling of the National Institutes of Health Clinical Center, Bethesda, Maryland, notes that before EBCT can be adopted as a routine test in evaluation of syndrome X, "it must provide better negative predictive value in order to reliably identify patients without CAD." However, he adds that technological advances and supplementary techniques "may yet establish a niche for EBCT."
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