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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary artery calcium scoring to exclude flow-limiting coronary artery disease in symptomatic stable patients at
Mohamed Mouden1, Jorik R Timmer, Stoffer Reiffers
1Departments of Cardiology and Nuclear Medicine, Isala Klinieken, Groot Wezenland 20, 8011 JW Zwolle, the Netherlands.
Insights
A zero coronary artery calcium (CAC) score effectively excludes flow-limiting coronary artery disease (CAD) in stable patients with low-to-intermediate risk. This supports CAC scoring as a safe tool for patient selection and management.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) remains a leading cause of mortality.
- Accurate risk stratification is crucial for managing patients with stable anginal complaints.
- Coronary artery calcium (CAC) scoring is a non-invasive imaging technique.
Purpose of the Study:
- To evaluate the utility of a zero CAC score in excluding flow-limiting CAD.
- To assess patients with stable angina and low-to-intermediate pretest likelihood of CAD.
- To determine if a zero CAC score can safely guide further diagnostic or management decisions.
Main Methods:
- A prospective study included 3501 stable patients without known CAD.
- Simultaneous myocardial perfusion imaging (SPECT) and CAC scoring were performed.
- A subgroup of 868 patients with a zero CAC score was analyzed.
- Coronary CT angiography and invasive angiography were used for further assessment when indicated.
Main Results:
- In the zero CAC score cohort (n=868), 88% had normal SPECT findings.
- Abnormal SPECT findings were observed in 12% of patients.
- Coronary CT angiography in 93 patients with abnormal SPECT revealed nonobstructive CAD in 9% and normal arteries in 91%.
- No coronary events were recorded during a median follow-up of 17 months.
Conclusions:
- A zero CAC score reliably excludes flow-limiting CAD in stable patients at low-to-intermediate risk.
- CAC scoring can serve as a simple, safe tool for patient selection for further testing or discharge.
- These findings support current guidelines recommending CAC scoring for risk stratification.
Purpose:
To assess the capability of a zero coronary artery calcium (CAC) score to help exclude flow-limiting coronary artery disease (CAD) in a homogeneous population with stable anginal complaints and a low-to-intermediate pretest likelihood.
Materials And Methods:
The study protocol had institutional ethics committee approval, with written informed consent from all patients. Between 2009 and 2011, a total of 3501 consecutive stable patients without known CAD underwent prospectively simultaneous myocardial perfusion imaging and CAC scoring on a hybrid, 64-section single photon emission computed tomography (SPECT)/computed tomography (CT) scanner. In 868 (25%) of 3501 patients, the CAC score was zero, and these patients constituted the current study population. When feasible, additional coronary CT angiography was performed in those with abnormal SPECT findings. Clinical follow-up was recorded with regard to invasive coronary angiography, coronary revascularization, nonfatal myocardial infarction, or death. Results were analyzed by using descriptive statistics.
Results:
In 868 patients (mean age, 54 years ± 11 [standard deviation]; 610 [70%] female, 258 [30%] male), SPECT findings were normal in 766 (88%) and abnormal in 102 (12%), with equivocal results in 41 (5%), persistent defect in 35 (4%), and ischemia in 26 (3%). In the group with abnormal SPECT findings, additional coronary CT angiography was performed in 93 patients (91%), showing nonobstructive CAD in eight patients (9%) and normal coronary arteries in 85 patients (91%). In the other nine patients (9%), invasive angiography was used to exclude obstructive CAD. At a median follow-up of 17 months (25th percentile, 11; 75th percentile, 24 months), no coronary events were recorded.
Conclusion:
A CAC score of zero in stable patients at low or intermediate risk excludes flow-limiting CAD. These findings support the possibility of CAC scoring as a simple and safe tool to select patients for additional testing or discharge, as recommended in the literature.
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