Download EISNER Trial Results Published: Coronary Artery - Cedars

SPRING 2011
EISNER Trial Results Published:
Coronary Artery Calcium Scans Help Patients Lower
Heart Disease Risk Without Increasing Tests and Costs
A new study of coronary artery calcium scanning (CCS) and major lifestyle modification, while those with high
has shown that the scan helps patients make heart- scores were motivated to take more aggressive steps to
healthy lifestyle changes and lower their heart disease reduce their risk.”
risk factors.
CCS shows plaques in coronary arteries long before
The study, the EISNER trial (Early Identification of symptoms develop and has been consistently shown
Subclinical Atherosclerosis by Noninvasive Imaging to effectively identify patients with silent heart disease
Research) was headed by researchers at Cedars-Sinai’s at risk for a heart attack or sudden death. The test is
Heart Institute and Cedars-Sinai’s S. Mark Taper Foun- rarely covered by insurance although a large number of
dation Imaging Department. The study results were studies have consistently shown that CCS detects these
published in the April 12, 2011 issue of the Journal of patients more accurately than standard blood tests.
the American College of Cardiology.
The current study found that patients who were screened
The EISNER trial, the largest randomized trial of CCS, had better long-term risk profiles than those who were
studied 2,137 volunteers with coronary risk factors but not. All 2,137 study volunteers in the EISNER trial had
no known heart disease, randomizing them to either an initial, private risk factor counseling session and
have or not have CCS, then followed the subjects for assessment of seven modifiable risk factors: blood prestheir risk-factor changes over four years. The final trial
results demonstrated that early screening does not increase subsequent tests and their associated costs.
“For patients who may be at risk for heart disease, coronary artery calcium scanning gives patients and their
doctors definitive anatomic evidence of plaques in the
coronary arteries and takes much of the guesswork out
of lifestyle management and medical procedure decision-making,” said Daniel S. Berman, MD, the study’s
principal investigator and chief of Cardiac Imaging and
Nuclear Cardiology at the Cedars-Sinai Heart Institute
and the S. Mark Taper Foundation Imaging Center. “In
our study, patients who knew their coronary calcium
scores were low were able to avoid unnecessary testing
Eye on Imaging | Spring 2011
Single Slice
Diagram of Heart
Abnormal Coronary Calcium
Scans show bright deposits
of calcium in the coronary
arteries, as shown in the
yellow circle in above image.
For a consult or to refer a patient, please call (310) 423-8000
sure, cholesterol and triglyceride profiles, blood sugar, There was no difference between the groups in the cost
weight, waist circumference, exercise, and smoking.
or use of invasive or noninvasive diagnostic and treatment procedures. Patients who had normal baseline
Of the total study participants, 1,424 were selected at scans had fewer tests and procedures in the subsequent
random to have CCS. The remaining 713 were assigned four years compared to patients who did not have scans.
to a no-scan group. Four years later, all available par- Drug costs were seven percent higher in the scan group
ticipants were reevaluated and both groups had CCS.
because more of these patients started taking blood
Compared to the no-scan group, subjects who under- pressure and cholesterol medications.
went initial scanning had significant improvement in Berman noted, “By showing improved patient outseveral risk factors after four years: systolic blood pres- comes with scanning – without increasing the need for
sure; LDL levels; waist size among those with large ab- subsequent tests – the EISNER trial will be very helpful
dominal circumference; and weight among those who in our quest to prevent heart attacks. The test isn’t for
were overweight.
everyone, but should be considered in patients with risk
An important outcome was that the Framingham Risk
Score, the widely used assessment tool that calculates a person’s overall risk of having a heart attack or
dying within 10 years, increased in the no-scan group,
but remained unchanged in those who had initial scans.
Individual risk factor profiles, based on the seven modifiable risk factors, improved in both groups, but the
degree of improvement was greater in the scan group.
factors for coronary artery disease who are in the right
age group.”
The EISNER trial was supported by a grant from the
Eisner Foundation. Dr. Berman has research grants
from Siemens and GE/Amersham.
Daniel S. Berman, MD
(310) 423-4223
[email protected]
Cardiac Imaging Innovator,
Daniel S. Berman, MD
Receives Pioneer in
Medicine Award
Patients around the world who undergo advanced heart
imaging studies benefit from the research and innovation of Daniel S. Berman, MD, chief of Cardiac Imaging and Nuclear Cardiology at the Cedars-Sinai Heart
Institute and Cedars-Sinai’s S. Mark Taper Foundation Imaging Center. Recently, Cedars-Sinai’s medical
staff recognized Berman’s achievements and influence,
awarding him its highest honor, the Pioneer in Medicine Award.
Dr. Berman is one of the world’s preeminent clinical investigators in non-invasive cardiac imaging and
one of the founding fathers of nuclear cardiology. He
established the largest and most extensively studied
patient database in the field of cardiac imaging. He also
co-directed a program to create software that enables
computers to analyze 3D images produced by advanced
imaging technologies. The automated software in nuclear cardiology is considered the gold standard.
Eye on Imaging | Spring 2011
Left to right: Steven S. Galen, MD, Vice Chief of Staff,
and Chair of the Pioneer in Medicine selection panel,
John D. Friedman, MD, Chief of Outpatient Cardiac
Imaging, Scott Karlan, MD, FACS, Chief of Staff,
Daniel S. Berman, MD, Chief of Cardiac Imaging
New Reduced Cash Price
The CCS cash price has been reduced to $185
(without consult).
For a consult or to refer a patient, please call (310) 423-8000
New ACC/AHA Guidelines Support
Coronary Calcium Scanning in Asymptomatic Patients
The American College of Cardiology (ACC) Foundation/American Heart Association (AHA) Task Force on
Practice Guidelines recently released new guidelines
for assessment of cardiovascular risk in asymptomatic
adults. For the first time, the new guidelines, which
are characteristically conservative, contain two Class
IIa indications, defined as “the weight of evidence or
opinion is in favor of the procedure or treatment,” for
Coronary Calcium Scanning (CCS):
• Asymptomatic patients with an intermediate
(10-20%) 10-year risk of cardiac events based on
the Framingham Risk Score (FRS) or other global
risk algorithms
• Asymptomatic patients >40 years old with diabetes
mellitus
The guidelines are based on a large number of studies involving more than 100,000 asymptomatic subjects which
consistently reported that CCS provides strong prognostic information for coronary artery disease (CAD). The
guidelines also considered recent multicenter studies that
have reported how standard clinical assessments such as
the FRS—based on coronary risk factors alone—are inferior to CCS in predicting cardiac events.
SUPER STAT Coronary CTA
In the emergency room, ruling out an acute coronary syndrome (ACS) in patients with chest pain
is of crucial importance for avoiding unnecessary
hospitalization of patients who do not have ACS
and for getting patients to the cath lab who need
such care. Coronary CTA provides an extremely
accurate method for these purposes and is most
applicable in patients presenting to the emergency
department with a low to intermediate likelihood
of ACS.
A new rapid coronary CTA process is now being implemented by the Ruth and Harry Roman
Emergency Department and the Department of
Imaging at Cedars-Sinai.
Time from ED order to reporting: 2 hours
Availability of study: 6 am to 5:30 pm
Monday through Friday
“The recommendation by major professional organizations in cardiology that coronary calcium be measured
is likely to have as great an impact on saving lives as
the recommendation that cholesterol be measured and
controlled,” says Daniel S. Berman, chief of Cardiac
Imaging and Nuclear Cardiology at the Cedars-Sinai
Heart Institute and Cedar-Sinai’s S. Mark Taper Foundation Imaging Center.
An abnormal CCS establishes the presence of underlying CAD and signals the need for aggressive risk-factor
management, which has been shown to prevent cardiac
events. The risk for future events increases in direct
proportion to CCS score elevation. Subjects with high
CCS scores may be candidates for cardiac stress testing
to rule out the presence of silent myocardial ischemia.
Application of these newly published guidelines may
represent a true breakthrough in our nation’s attempt to
eliminate unnecessary myocardial infarction and coronary deaths due to unrecognized heart disease.
Imaging’s White
Glove Service
“As Imaging’s Patient
Care Advocate, my goal is
to assist your patients with
their unique needs.”
- Paula Rubin
Our White Glove Service applies to all modalities
and is offered to those patients with specialized
needs. The service includes:
• Personalized scheduling
• Flexible appointment hours
• Expedited registration
• Private entrance with escort
• Private waiting area
•Patient accompanied throughout the visit
•Special attention to privacy needs
• Additional security when necessary
If you feel any of your patients require this
service, please contact Paula Rubin directly at
(310) 423-3268 or [email protected].
Case of the Month
A 78-year-old female presented with severe acute non-pleuritic,
substernal chest pain. ECG and cardiac enzymes were normal.
A coronary CT angiogram was performed.
Selected patient images are shown on the left.
What’s your diagnosis?
A) Superior vena cava thrombosis
B) Pulmonary embolism
C) Aortic dissection and rupture
D) Acute myocardial infarction
For the answer, please visit
www.csmc.edu/caseofthemonth
To refer a patient, please call (310) 423-8000
www.csmc.edu/imaging
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