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April 21, 2004

Use of Coronary Calcification Scores to Predict Coronary Heart Disease

JAMA. 2004;291(15):1831. doi:10.1001/jama.291.15.1832-a

To the Editor: Dr Greenland and colleagues1 stated that "absence of CACS did not preclude the risk of a CHD [coronary heart disease] event as has been reported in some other studies." However, in explaining why individuals without detectable CAC might experience coronary events, the authors did not consider that their scanning methodology used a 6-mm scan thickness, twice the scan thickness used in other prognostic studies. For instance, Callister et al2 evaluated patients with both 3-mm and 6-mm scans and concluded that "[a] 6-mm slicing protocol is significantly less sensitive than a 3-mm protocol for the detection and quantification of CAC. Since one-third of coronary events occur in patients with low CACS, a 6-mm protocol might be unreliable for risk assessment because of substantial loss of information."