August 15, 2013 — Former President George W. Bush underwent heart surgery on the morning of Aug. 6, 2013, to receive a stent after an artery blockage was discovered during his annual physical. The routine physical included a stress test and an electrocardiogram. Abnormal results from the stress test prompted the former president to receive a computed tomography (CT) angiogram, and the surgery successfully took place one day after the blockage was discovered.
Stress tests are generally not part of a routine physical and are more common when the patient is symptomatic or shows clear risk factors. However, the former president also received a positive calcium score test in 2006, which showed mild calcification of the coronary arteries, and his physicians placed him on cholesterol lowering medications at that time.
"The calcium score, while only mildly positive by report, is the strongest indicator of future cardiovascular events in asymptomatic persons, and is being used more widely in risk screening," says Matthew Budoff, M.D., program director of cardiology at Los Angeles Biomedical Research Center, and former president of the Society of Cardiovascular Computed Tomography (SCCT). "Unlike the stress test, CAC is recommended as a screening tool in asymptomatic persons, and was used appropriately in this case. Years later, after a positive stress test, he underwent a CT angiogram to assess the severity of his CAD, and was found to have severe single vessel disease. Thus, President Bush underwent, appropriately, a calcium score for risk stratification and years later, a CT angiogram to assess the accuracy of a stress test."
The former president is expected to recover without incident.
For more information: www.SCCT.org
May 05, 2023 
![Figure 1. Flow chart of machine learning workflow. A machine learning (ML) model for the prediction of vessel-specific ischemia was built, trained, and tuned in the NXT trial (Analysis of Coronary Blood Flow using CT Angiography: Next Steps). The model’s predictive performance was evaluated in the PACIFIC trial (Prospective Comparison of Cardiac Positron Emission Tomography [PET]/Computed Tomography [CT]‚ Single Photon Emission Computed Tomography [SPECT]/CT Perfusion Imaging and CT Coronary Angiography wit](/sites/default/files/styles/content_feed_medium/public/Figure1.jpg?itok=Gz8S08BV)
