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

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

There remains 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.

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 Foundation/American Heart Association. (2007). ACF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain. Journal of the American College of Cardiology, 49 (3), 378-402.

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 Cardiology Foundation, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. (2006). Appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. Retrieved June 27, 2018 from www.acc.org.

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. (9:2017). Computed tomography to detect coronary artery calcification. (6.01.03). Retrieved May 2, 2018 from BlueWeb. (43 articles and/or guidelines reviewed)

Cho, I., Ó Hartaigh, B., Gransar, H., Valenti, V., Lin, F.Y., Achenbach, S., et al. (2016). Prognostic implications of coronary artery calcium in the absence of coronary artery luminal narrowing. Atherosclerosis, 262, 185-190. Abstract retrieved May 4, 2018 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 May 3, 2018 from http://www.nice.org.uk/guidance/cg95.

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.

Palmetto Government Benefit Administrators. (2018, February). LCD for cardiac computed tomography & angiography (CCTA). (L33423). Retrieved May 3, 2018 from https://www.cms.gov.

Peters, S., den Ruijter, H., Bots, M., & Moons, K. (2012). Improvements in risk stratification for the occurrence of cardiovascular disease by imaging subclinical atherosclerosis: a systematic review. Heart, 98, 177-184. (Level 1 evidence)

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; last update search February 2018). Coronary artery calcium scoring for risk assessment and stratification of coronary artery disease in asymptomatic adults. Retrieved May 3, 2018 from www.Hayesinc.com/subscribers. (58 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  8/1998  

MOST RECENT REVIEW DATE:  8/9/2018

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