Why You Should Get a Coronary Computed Tomography Angiography (CCTA) Test

Dr. Steve Parcell and NatureMed Integrative Medicine have partnered with Cleerly to provide the most detailed noninvasive analysis of coronary artery plaque available. Cleerly uses supercomputing to identify, characterize, and quantify arterial plaque. This test outperforms stress tests and calcium scoring alone in terms of both sensitivity and specificity.

A coronary computed tomography angiography (CCTA) test from Cleerly has higher sensitivity and specificity compared to traditional stress tests and calcium scoring. Read on to find out why.
Image courtesy of Cleerly

 

The Limitations of a Coronary Artery Calcium (CAC) Scoring Scan

20 years ago, Coronary Artery Calcium (CAC) scoring scans were the cutting edge in preventive cardiology. Now it is an aging technology with limited use compared to a CT angiogram. Calcium scoring adds value to a complete cardiology work-up (electrocardiogram, echocardiogram and a stress test) because it provides an estimate of calcified plaque. It can help individualized treatment for a patient who is asymptomatic. But by the time there is chest pain from blocked arteries it is too late and calcium scoring is not helpful. In these cases, the patient will typically, but not always, fail the stress test, ECG, and an angiogram will show blocked arteries.

A traditional CAC scoring scan can detect calcified arterial plaque and is much better than just guessing if the patient has plaque or not. However, it cannot detect and quantify low-density, non-calcified plaque, which is more likely than hardened and calcified plaque to rupture and cause a blood clot to form. Simply put, a CAC score of zero does not exclude the presence of high-risk plaque.

Cleerly uses CCTA images to identify, characterize, and quantify plaque buildup. Several studies have concluded that CCTA shows coronary atherosclerosis in 41% to 53% of patients with a CAC score of zero. The Western Denmark Health Study further found that 31% of major adverse cardiac events occur in patients with a CAC score of zero!

The healthcare system misses more than half of patients who appear to be the picture of health but suffer a heart attack because they have a buildup of non-calcified plaque that a traditional CAC scan misses.

Cleerly’s CT angiogram identifies patients at a high risk of coronary artery disease sooner and with greater detail than the traditional CAC scan. This can help physicians prevent heart attacks.

 

Why a CCTA Test is Better Than a Stress Test

The stress test is one of the most commonly used tools to determine someone’s heart attack risk, with more than eight million ordered annually in the United States.

There are limitations associated with a stress test. A stress test can only determine whether an artery is more than 70% blocked, and it cannot detect whether a plaque will rupture, lead to the formation of blood clots, and occlude an artery. In fact, 90% of stress tests come back with normal results. A stress test may give both providers and patients a false sense of security when, in fact, they have advanced atherosclerosis.

There are many documented cases of patients dying within a week of having a normal stress test. The reason for this is that most heart attacks occur when a piece of plaque and artery ruptures. Prior to the rupture there will be no symptoms and no blood flow restriction to the heart.

Cleerly uses supercomputing and sophisticated software to identify, characterize, and quantify plaque buildup. This model outperforms stress tests alone in terms of both sensitivity (95% vs. 74%), and specificity (63% vs. 43%) for detecting stenosis (narrowing) greater than 50%.

 

How a CCTA Test Works

A CAC cannot detect the percent blockage or the type of plaque that is there. There are three types of plaque: low-density plaque, noncalcified plaque, and calcified plaque. The low-density plaque is more likely than calcified plaque to rupture and cause a heart attack. Simply put, a CAC score of zero does not exclude the presence of high-risk plaque.

Cleerly’s analysis of CCTA images characterize the type and quantify the amount of arterial plaque buildup. Several studies have concluded that CCTA shows coronary atherosclerosis in 41% to 53% of patients with a CAC score of zero! The Western Denmark Health Study further found that 31% of major adverse cardiac events occur in patients with a CAC score of zero.

I feel that heart attack prevention starts with objective data and diagnosis, not guess work. Patients are treated on a case-by-case basis. Everyone is unique in my practice. For this reason, the treatment plan is customized to each person’s individual circumstances. There are no “one size fits all” protocols.

Why guess when you could know? A penny of prevention is worth a pound of cure.

Learn more about Cleerly here: Cleerly.

For more information on CCTA and Cleerly, download this guide: What to Expect with CCTA Test

If you are a current patient we can order this for you. If you are not a patient and are interested in a truly individualized preventive cardiology program, please call our front desk at 303.884.7557.

 

Sources:

Coronary Atherosclerotic Precursors of Acute Coronary Syndromes. Journal of the American College of Cardiology. June 5, 2018.

Prognostic Value of Coronary CTA in Stable Chest Pain: CAD-RADS, CAC, and Cardiovascular Events in PROMISE. Journal of the American College of Cardiology. July 13, 2020.

SCOT-HEART Trial: Reshuffling Our Approach to Stable Ischemic Heart Disease. British Journal of Radiology. September 1, 2020.

8 Million Nuclear Stress Tests are Performed in the US. Is This Necessary? Oliver Wyman, April 8, 2019.

Cardiac exercise stress testing: What it can and cannot tell you. Harvard Health Publishing. April 15, 2020.

Temporal Trends in the Frequency of Inducible Myocardial Ischemia During Cardiac Stress Testing. Journal of the American College of Cardiology. March 12, 2013.

Coronary CTA With AI-QCT Interpretation: Comparison With Myocardial Perfusion Imaging for Detection of Obstructive Stenosis Using Invasive Angiography as Reference Standard. American Journal of Roentgenology. April 20, 2022.

The Fallacy of the Power of Zero. Journal of the American College of Cardiology: Cardiovascular Imaging. June 2022.

The Swedish CardioPulmonary BioImage Study: objectives and design. Journal of Internal Medicine. December 2015.

The Fallacy of the Power of Zero. JACC: Cardiovascular Imaging. June 2022.

The Western Denmark Heart Registry: Its Influence on Cardiovascular Patient Care. Journal of the American College of Cardiology. March 20, 2018.