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On paper, Lisa Goldstein was a cardiologist's dream: She had low cholesterol, healthy blood pressure, a good diet and a regular exercise program - essentially zero risk factors for heart disease, aside from family history.

And the 51-year-old marathon runner was confident she had that beat.

"My lifestyle is so much different than my family's, I figured I had a pretty big leg up on it," says Goldstein, a mother of two.

Thanks to a gift certificate for a heart scan she bought at a school fund-raiser and left tucked in a drawer for five months, Goldstein recently learned otherwise - and she believes it saved her life.

While training for the New York Marathon, she dusted off the coupon, went in for her scan at Front Range Preventive Imaging in Boulder, Colo., and discovered her presumably healthy arteries were so clogged with calcified plaque that only 3 percent of women her age scored worse.

She went on medication and kept training anyway, but this time she took care to wear a heart rate monitor, limit her hill climbing and not push too hard. Three days after the race, further tests confirmed she had a 95 percent blockage in a major artery, and she underwent surgery to open it.

"The cardiologist said he was surprised I didn't drop dead of a heart attack on the course," says Goldstein, who credits the scan for motivating her to "train smarter." "If I hadn't had that heart scan I don't think I would have even made it to the marathon."

Twelve years after the ultrafast Computed Tomography, or CT, scan began to emerge at high-end direct-to-consumer medical boutiques around the country, the once-shunned heart scan has gone from being seen by doctors as a fleeting fad to being embraced as a critical way to prevent heart attacks.

In January, the American Heart Association and the American College of Cardiology Foundation published a joint statement recommending that patients with no symptoms, but "intermediate risk" of developing heart disease consider getting a heart scan, an endorsement that some believe could open the doors for more insurance companies to cover the tests.

Meanwhile, a few emergency rooms around the country have begun using heart scans on patients who arrive with chest pains, hoping to better recognize and treat those for whom a heart attack is truly imminent and stop overtreating false alarms.

"If more people understood this technology and used it, so many lives could be saved," says William Blanchet, who - after 20 years as an internist - invested in a half-million-dollar Electron Beam CT heart scanner four years ago and opened Front Range Preventive Imaging, a free-standing center adjoining his practice in Boulder.

"This allowed me to do a better job at being an internist. Without it, I couldn't tell which of my patients were at risk."

CT scanners work by taking 3-D images of arteries, giving doctors and their patients an idea of how much calcified plaque has built up over the years, narrowing blood flow. Because most heart attacks occur when that plaque becomes unstable and bursts, identifying its presence is critical in identifying those at risk of a coronary event, yet until the birth of the heart scan it was difficult to do that.

"The real way to prevent heart attacks and coronary death is to find out who needs to be treated and treat them properly early on. That's what this technology allows us to do," Blanchet says.

According to the American Heart Association, a staggering 38 percent of Americans die from heart attacks, and for half of those men and 64 percent of those women, the first symptom of heart disease is the heart attack that kills them.

Doctors typically use risk factors such as cholesterol levels, blood pressure and lifestyle choices like smoking to predict who is at risk enough to be put on medication. They use stress tests to determine who is a candidate for a stent or bypass surgery.

But studies have shown that such diagnostic tests are far from foolproof:

According to one 2003 study published in the Journal of the American Medical Association, 20 percent of people who have a heart attack have no prior risk factors at all and 62.4 percent have zero to 1.

Because a stress test only becomes positive when there is a 70 percent or greater blockage in a vessel, it often misses insidious but not yet obstructive plaque that can later cause a heart attack, doctors say.

"Stress tests give us a lot of inappropriate reassurance," says Blanchet, pointing to research that estimates 86 percent of heart attacks will occur in vessels considered normal by stress testing.

"Our standard guidelines just don't predict risk very well. We have been doing it all wrong."