Electron-beam computed tomography for detection of early signs of coronary arteriosclerosis

Cardiovascular mortality is still the leading cause of death in the western world. Whereas a steady decline is observed in countries like the Netherlands, eastern European countries have experienced an increase. Economic barriers to effective treatment alone are unlikely to explain the mortality changes observed, according to Sans et al.. Most deaths from cardiovascular disease occur outside the hospital, and lead to a fatality rate of 40–60% in Europe. Twenty years ago, in 1978 the inventor of coronary angiography F. N. Sones stated: ‘One third of the patients die due to complications of coronary artery disease, before the physicians know that the patient is ill’. The most important aim, he saw, was the identification of patients at risk. Brown and Goldstein have described the major challenge for the future in cardiology: ‘The aim should be the development of a noninvasive method, for identification of coronary artery disease at its earliest stage’. Based on the data of the World Health Organisation MONICA project, it has recently been pointed out that two thirds of the patients with acute myocardial infarction die within the first 28 days after the event. Only a strategy of primary risk reduction will substantially reduce cardiovascular mortality, as in-hospital treatment will only help a limited number of patients. During the last decade new imaging modalities — transoesophageal echocardiography, magnetic resonance tomography, spiral computed tomography, electron beam computed tomography — have been introduced which have improved the diagnostic capabilities of the non-invasive imaging of coronary arteries.