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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
04:40

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Published on: August 28, 2018

Coronary Artery Calcium Testing in Symptomatic Patients: An Issue of Diagnostic Efficiency

Chad B McBride1, Michael K Cheezum, Rosco S Gore

  • 1Cardiology Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue., Bethesda, MD 20850 USA.

Current Cardiovascular Imaging Reports
|June 25, 2013
PubMed

Insights

Coronary artery calcium (CAC) scoring aids cardiovascular risk prediction. For symptomatic patients, coronary computed tomographic angiography is preferred over CAC testing due to better accuracy and lower radiation exposure.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Preventive Medicine

Background:

  • Coronary artery calcification (CAC) detection improves cardiovascular risk prediction in asymptomatic individuals.
  • CAC testing in symptomatic patients with possible angina is debated due to high prevalence and low specificity for obstructive coronary artery disease (CAD).
  • Current evidence lacks adequately powered studies on the comparative effectiveness of a 'CAC first' approach in symptomatic patients.

Purpose of the Study:

  • To evaluate the role and limitations of CAC testing in symptomatic patients.
  • To compare CAC testing with coronary computed tomographic angiography (CCTA) for diagnosing obstructive CAD in symptomatic individuals.
  • To assess the optimal CT-based imaging strategy for symptomatic patients with suspected CAD.

Main Methods:

  • Review of existing literature and clinical guidelines regarding CAC and CCTA in symptomatic patients.
  • Analysis of the diagnostic accuracy, prognostic value, and limitations of CAC testing.
  • Comparison of radiation exposure, cost-effectiveness, and clinical outcomes between CAC-first and CCTA-first strategies.

Main Results:

  • While absence of CAC suggests low risk, high CAC prevalence in symptomatic populations necessitates further testing, reducing specificity.
  • Coronary computed tomographic angiography offers higher accuracy and prognostic value compared to CAC for obstructive CAD in symptomatic patients.
  • CCTA demonstrates reduced patient radiation exposure and is considered the preferred CT-based test for selected symptomatic individuals.

Conclusions:

  • CAC testing has limitations in symptomatic patients due to high prevalence and low specificity, often requiring additional 'test layering'.
  • Coronary computed tomographic angiography is the preferred CT-based diagnostic tool for appropriately selected symptomatic patients due to its accuracy, prognostic value, and lower radiation exposure.
  • Further prospective studies are needed to fully validate the 'CAC first' approach in symptomatic populations regarding comparative effectiveness.

Keywords:
Cardiac computed tomographyCardiovascular riskChest painCoronary artery calcificationCoronary artery diseaseCoronary calciumCoronary computed tomography angiographyCoronary heart diseaseGuidelinesStress testing

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