BlueCross BlueShield of Tennessee Medical Policy Manual

Computed Tomography to Detect Coronary Artery Calcification (i.e., calcium scoring)

DESCRIPTION

Several types of fast computed tomography (CT) imaging, including electron beam (EBCT), helical, multislice spiral, or multidetector row, allow the quantification of calcium (i.e., calcium scoring) in coronary arteries.  Coronary artery calcium is present in coronary atherosclerosis, but the atherosclerosis detected may or may not cause ischemia or symptoms.  The most widely studied indication for the use of calcium scoring is the prediction of future risk for coronary artery disease in individuals with subclinical disease. In addition, calcium scoring has been evaluated in individuals with symptoms potentially consistent with coronary artery disease, but in whom a diagnosis is unclear.

POLICY

See also: Coronary Computed Tomography Angiography (CCTA)

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

Due to a lack of high-quality evidence demonstrating improved outcomes from the use of coronary artery calcium scoring either as a screening tool for risk stratification or as a diagnostic tool in symptomatic individuals, the use of CAC scoring is considered investigational.

SOURCES 

American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. (2013) ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 Multimodality appropriate use criteria for the detection and risk assessment of stable Ischemic Heart Disease. Journal of the American College of Cardiology, 63 (4), 380-406.

American College of Cardiology/American Heart Association. (2014, July). 2013 ACC/AHA guideline on the assessment of cardiovascular risk. Retrieved April 4, 2016 from the National Guideline Clearinghouse (NCG: 010480).

American College of Cardiology/American Heart Association/American College of Physicians/American Association for Thoracic Surgery/Preventive Cardiovascular Nurses Association/Society for Cardiovascular Angiography and Interventions/Society of Thoracic Surgeons. (2012, December). 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease. Retrieved April 5, 2016 from the National Guideline Clearinghouse (NCG: 009551).

American College of Radiology/North American Society of Cardiovascular Imaging/Society for Pediatric Radiology. (2016). ACR-NASCI-SPR practice parameter for the performance and interpretation of cardiac computer tomography (CT). Retrieved February 22, 2017 from the American College of Radiology.

American College of Radiology. (2012). ACR Appropriateness Criteria® chronic chest pain – low to intermediate probability of coronary artery disease. Retrieved April 4, 2016 from the National Guideline Clearinghouse (NCG: 009221).

American College of Radiology. (2013). ACR Appropriateness Criteria® asymptomatic patient at risk for coronary artery disease. Retrieved April 4, 2016 from the National Guideline Clearinghouse (NCG: 010141).

BlueCross BlueShield Association, Medical Policy Reference Manual. (9:2016). Computed tomography to detect coronary artery calcification. (6.01.03). Retrieved February 22, 2017 from BlueWeb. (43 articles and/or guidelines reviewed)

Centers for Medicare & Medicaid Services, CMS.gov. LCD for cardiac computed tomography (CCT) and coronary computed tomography angiography (CCTA) (L33559). Retrieved February 22, 2017 from https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33559.

Mamudu, H., Paul, T., Veeranki, S., & Budoff, M. (2014). The effects of coronary artery calcium screening on behavioral modification, risk perception, and medication adherence among asymptomatic adults: a systematic review. Atherosclerosis, 236 (2), 338-350.  Abstract retrieved April 5, 2016 from PubMed database.

National Institute for Health and Clinical Excellence. (2010). Chest pain of recent onset: Assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin. Retrieved April 5, 2016 from http://www.nice.org.uk/nicemedia/live/12947/47938/47938.pdf.

Paixao, A. R., Ayers, C. R., El Sabbagh, A., Sanghavi, M., Berry, J. D., Rohatgi, A., et al. (2015). Coronary artery calcium improves risk classification in younger populations. Journal of the American College of Cardiology, 8 (11), 1285-1293. Abstract retrieved February 22, 2017 from PubMed database.

Urbonaviciene, G., Isaksen, C., Urbonavicius, S., Buhl, J., Johansen, J., Nielsen, A., et al. (2016). Coronary computed tomography angiography and calcium scoring in routine clinical practice for identification of patients who require revascularization. Archives of Cardiovascular Diseases, 109 (6-7), 412-421. Abstract retrieved February 22, 2017 from PubMed database.

U. S. Food and Drug Administration. (2007, February) Center for Devices and Radiological Health. Pre-market approval K063608. Retrieved October 27, 2009 from http://www.accessdata.fda.gov/cdrh_docs/pdf6/K063608.pdf.

U. S. Food and Drug Administration. (2011, August). Center for Devices and Radiological Health. Pre-market approval K111373. Retrieved December 12, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf11/K111373.pdf.

U. S. Food and Drug Administration. (2011, September). Center for Devices and Radiological Health. Pre-market approval K112530. Retrieved December 12, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf11/K112530.pdf.

U. S. Food and Drug Administration. (2014, August). Center for Devices and Radiological Health. Pre-market approval K141480. Retrieved February 23, 2015 from http://www.accessdata.fda.gov/cdrh_docs/pdf11/K141480.pdf.

U. S. Preventive Services Task Force. (2009, October). Using nontraditional risk factors in coronary heart disease risk assessment: U. S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 151 (7), 474-482.

Winifred S. Hayes, Inc. Medical Technical Directory. (2017, February). Coronary artery calcium scoring for risk assessment and stratification of coronary artery disease in asymptomatic adults. Retrieved February 22, 2017 from www.Hayesinc.com/subscribers. (58 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  8/1998

MOST RECENT REVIEW DATE:  4/13/2017   

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