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

McBride, Chad; Cheezum, Michael K.; Gore, Rosco; Pathirana, Induruwa; Slim, Ahmad; Villines, Todd C.

doi:10.1007/s12410-013-9198-0

Cited by 13 publications

(6 citation statements)

References 66 publications

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“…However, all those have significant limitations. Resting 12-lead ECG lacks adequate sensitivity and negative predictive, (12,13) and exercise ECG is a useful tool only in ambulatory patients for the detection of CAD. (14,15) Resting 2-D echocardiography (echo) has low sensitivity to predict cardiac events in patients with possible ACS (16) whereas, stress echo requires experienced technicians and readers with good image quality to maintain diagnostic accuracy and reproducibility (17).Single photon-emission CT (18) and perfusion imaging (19) are not ideal for initial evaluation and to rule out ACS for several reasons including cost, substantial exposure to radiation, time to perform a test and required a trained technician.…”

Section: Functional and Anatomical Cardiac Testing In Symptomatic Patientsmentioning

confidence: 99%

Coronary artery calcium score: pivotal role as a predictor for detecting coronary artery disease in symptomatic patients

Cherukuri

Birudaraju

Budoff

2021

Coronary Artery Disease

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Chest pain and dyspnea are common presentations for symptomatic individuals with suspected CAD in the primary care office and cardiology clinics. However, it is imperative to properly diagnose who should undergo further evaluation for cardiac etiologies of chest pain, with either non-invasive or invasive imaging tests. The purpose of this review is to highlight the role of coronary artery calcium (CAC) score as a screening tool for symptomatic patients to detect CAD. The purpose of CAC scoring is to establish the presence and severity of coronary atherosclerosis and can play a vital role in symptomatic patients. The use of CAC testing in symptomatic patients has traditionally been limited due to fundamental concerns including the occurrence of coronary calcification relatively late in the atherosclerotic process and high prevalence of CAC in the population.Further issue relate to its low specificity for obstructive CAD, as well as demonstration of significant ethnic variability in plaque composition and calcification patterns.CAC testing as gained attention as an inexpensive, rapid, reproducible and a safe alternative to exclude CAD in symptomatic patients and defer further invasive imaging tests. This paper will review the available literature in regards to use of CAC in symptomatic populations. Introduction:Coronary artery disease (CAD) is a leading cause of cardiovascular mortality accounting for 42.6% of all such deaths followed by stroke (17%).(1) For the past few decades, the pretest probability (PTP) of obstructive CAD was assessed based upon symptom presentation and known cardiovascular (CV) risk factors such as hypertension, hyperlipidemia, family history of CAD, and

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Section: Functional and Anatomical Cardiac Testing In Symptomatic Patientsmentioning

confidence: 99%

Coronary artery calcium score: pivotal role as a predictor for detecting coronary artery disease in symptomatic patients

Cherukuri

Birudaraju

Budoff

2021

Coronary Artery Disease

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“…It has also been reported that the CAC score positively correlates with the number of coronary vessels affected by CAD, even in patients with proven CAD 35) , while an elevated CAC score is associated with higher morbidity and mortality rates 36) . Nevertheless, the general use of CAC scoring may be limited, as the high prevalence of CAC results in low specificity for obstructive CAD in symptomatic patients 37) . Furthermore, while the use of CAC scoring to guide decisionmaking regarding coronary CT is well established, the application of the CAC score for this purpose with respect to contrast-enhanced examinations has not been validated.…”

Section: Cac Score and Cardiovascular Morbidity And Mortality In The mentioning

confidence: 99%

Clinical Implications of the Coronary Artery Calcium Score in Japanese Patients

Yamamoto

Kitagawa

Kihara

2014

JAT

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Coronary artery calcification (CAC) is a well-established surrogate marker of the total burden of coronary atherosclerosis. The CAC score, as measured on coronary computed tomography (CT), is associated with the prevalence of coronary artery disease (CAD) as well as cardiovascular morbidity and mortality. The CAC score is used to reclassify coronary risks in asymptomatic individuals with intermediate risks. However, there are few clinical data regarding the usefulness of the CAC score for identifying high-risk Japanese patients. In this review article, we describe our previous studies of the prognostic value of the CAC score in patients with proven or suspected CAD. In addition, we reanalyzed our previous data for 723 patients with suspected CAD and found both all-cause and cardiovascular disease mortality to be significantly higher among the patients with a CAC score of ≥ 100 than among those with a CAC score of ＜100. Several studies from Japan have also shown that the CAC score is associated with the prevalence of obstructive CAD, as demonstrated on invasive coronary angiography or stress myocardial perfusion imaging. Furthermore, the CAC score provides useful information for performing coronary CT angiography, as asymptomatic patients without CAC are expected to have favorable outcomes. In contrast, the diagnostic accuracy is decreased in patients with a high CAC score (＞400 or 600). In conclusion, the CAC score may have useful clinical applications in symptomatic and asymptomatic Japanese individuals. However, further studies are required to evaluate the prognostic value of this parameter for predicting cardiovascular morbidity and mortality in population-based analyses of asymptomatic Japanese subjects.

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“… 7 Among symptomatic patients, CAC generally has a high sensitivity and negative predictive value for excluding significant CAD and subsequent adverse cardiovascular events when performed in low-risk and intermediate-risk patients. 8 9 Although there are previous studies about associations between CAC and CAD, and the prognostic impact of CAC for cardiovascular outcomes, the sex-specific impact of CAC for CAD diagnosis is unclear. 9–11…”

Section: Introductionmentioning

confidence: 99%

Sex differences in impact of coronary artery calcification to predict coronary artery disease

Nakao

Miyamoto

Higashi

et al. 2018

Heart

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ObjectiveTo assess sex-specific differences regarding use of conventional risks and coronary artery calcification (CAC) to detect coronary artery disease (CAD) using coronary CT angiography (CCTA).MethodsThe Nationwide Gender-specific Atherosclerosis Determinants Estimation and Ischemic Cardiovascular Disease Prospective Cohort study is a prospective, multicentre, nationwide cohort study. Candidates with suspected CAD aged 50–74 years enrolled from 2008 to 2012. The outcome was obstructive CAD defined as any stenosis ≥50% by CCTA. We constructed logistic regression models for obstructive CAD adjusted for conventional risks (clinical model) and CAC score. Improvement in discrimination beyond risks was assessed by C-statistic; net reclassification index (NRI) for CAD probability of low (<30%), intermediate (30%–60%) and high (≥60%); and risk stratification capacity.ResultsAmong 991 patients (456 women, 535 men; 65.2 vs 64.4 years old), women had lower CAC scores (median, 4 vs 60) and lower CAD prevalence (21.7% vs 37.0%) than men. CAC significantly improved model discrimination compared with clinical model in both sexes (0.66–0.79 in women vs 0.61–0.83 in men). The NRI for women was 0.33, which was much lower than that for men (0.71). Adding CAC to clinical model had a larger benefit in terms of moving an additional 43.3% of men to the most determinant categories (high or low risk) compared with −1.4% of women.ConclusionsThe addition of CAC to a prediction model based on conventional variables significantly improved the classification of risk in suspected patients with CAD, with sex differences influencing the predictive ability.Trial registration numberUMIN-CTR Clinical Trial: UMIN000001577.

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

Cited by 13 publications

References 66 publications

Coronary artery calcium score: pivotal role as a predictor for detecting coronary artery disease in symptomatic patients

Coronary artery calcium score: pivotal role as a predictor for detecting coronary artery disease in symptomatic patients

Clinical Implications of the Coronary Artery Calcium Score in Japanese Patients

Sex differences in impact of coronary artery calcification to predict coronary artery disease

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