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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Should computed tomography coronary angiography be aborted when the calcium score exceeds a certain threshold in
Jose Alberto de Agustin1, Pedro Marcos-Alberca, Covadonga Fernández-Golfin
1Instituto Cardiovascular, Unidad de Imagen Cardiaca, Hospital Universitario San Carlos, Profesor Martin Lagos, 28040 Madrid, Spain. albertutor@hotmail.com
Insights
A calcium score (CS) of 400 or higher in patients with chest pain strongly predicts severe coronary stenoses. This finding suggests using CS as a gatekeeper to avoid unnecessary computed tomography coronary angiography (CTCA).
Area of Science:
- Cardiovascular imaging
- Radiology
- Preventive cardiology
Background:
- Debate exists on aborting computed tomography coronary angiography (CTCA) based on elevated calcium scores (CS) in chest pain patients.
- Determining reliable CS cut-points can identify patients needing invasive angiography, optimizing diagnostic pathways.
Purpose of the Study:
- To establish specific coronary artery calcium score (CS) cut-points for predicting severe coronary stenoses via CTCA.
- To identify patients suitable for invasive diagnostic procedures based on CS thresholds.
Main Methods:
- 294 chest pain patients underwent non-invasive diagnostic CTCA and Agatston CS using 64-slice technology.
- Analysis focused on correlating CS values with the presence of severe coronary stenoses detected by CTCA.
Main Results:
- Severe coronary stenoses were present in 25.1% of patients.
- A CS ≥ 400 indicated an 87.0% prevalence of severe coronary stenoses.
- A CS cut-off of ≥ 400 demonstrated high specificity (93.5%) and PPV (85.8%) for severe stenoses, independently predicted by CS (OR 14.553).
Conclusions:
- Coronary artery calcium score (CS) can serve as an effective gatekeeper for CTCA in chest pain evaluations.
- Patients with CS ≥ 400 have a high likelihood of severe coronary stenoses, warranting direct referral to invasive coronary angiography.
- This approach minimizes radiation exposure and contrast agent use by avoiding further CTCA in high-risk individuals.
Background:
There is ongoing debate about whether a computed tomography coronary angiography (CTCA) should be aborted when the calcium score (CS) exceeds a certain threshold in patients with chest pain. The aim of this study was to discover whether specific "cutpoints" regarding coronary artery CS could be determined to predict severe coronary stenoses assessed by CTCA, thus identifying patients amenable to an invasive diagnostic approach.
Methods:
294 consecutive patients with chest pain of uncertain cause who were referred for non-invasive diagnostic CTCA were included. Subjects underwent Agatston CS and CTCA using current 64-slice technology.
Results:
Severe coronary stenoses were noted in 75 of 294 (25.1%) patients on CTCA. A very high prevalence of severe coronary stenoses was found in patients with CS ≥ 400 (87.0%). The CS had area under the ROC curve 0.86 to predict severe coronary stenoses on CTCA. The best discriminant cut-off point was CS ≥ 400 (sensitivity of 55.3%, specificity of 93.5, positive predictive value of 85.8%, negative predictive value of 84.0%). Multivariable logistic regression analysis controlling for traditional risk factors showed CS ≥ 400 remained an independent predictor of severe coronary stenoses on CTCA (OR 14.553, 95% confidence interval 4.043 to 52.384, p<0.001).
Conclusions:
CS can be used as a "gatekeeper" to CTCA in patients with chest pain. Due to the very high prevalence of severe coronary stenoses in patients with CS ≥ 400, further evaluation with CTCA is not warranted as these patients should be referred to invasive coronary angiography, avoiding the repeated exposure to ionizing radiation and iodinated contrast.
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