Measurement of coronary calcium scores by electron beam computed tomography or exercise testing as initial diagnostic tool in low-risk patients with suspected coronary artery disease

Abstract

We determined the efficiency of a screening protocol based on coronary calcium scores (CCS) compared with exercise testing in patients with suspected coronary artery disease (CAD), a normal ECG and troponin levels. Three-hundred-and-four patients were enrolled in a screening protocol including CCS by electron beam computed tomography (Agatston score), and exercise testing. Decision-making was based on CCS. When CCS≥400, coronary angiography (CAG) was recommended. When CCS<10, patients were discharged. Exercise tests were graded as positive, negative or nondiagnostic. The combined endpoint was defined as coronary event or obstructive CAD at CAG. During 12±4 months, CCS≥400, 10–399 and <10 were found in 42, 103 and 159 patients and the combined endpoint occurred in 24 (57%), 14 (14%) and 0 patients (0%), respectively. In 22 patients (7%), myocardial perfusion scintigraphy was performed instead of exercise testing due to the inability to perform an exercise test. A positive, nondiagnostic and negative exercise test result was found in 37, 76 and 191 patients, and the combined endpoint occurred in 11 (30%), 15 (20%) and 12 patients (6%), respectively. Receiver-operator characteristics analysis showed that the area under the curve of 0.89 (95% CI: 0.85–0.93) for CCS was superior to 0.69 (95% CI: 0.61–0.78) for exercise testing ( P <0.0001). In conclusion, measurement of CCS is an appropriate initial screening test in a well-defined low-risk population with suspected CAD.

Risk stratification of patients with acute chest pain without a rise in troponin: current practice in England

“…CT assessment of coronary calcium scores (CCSs) has been demonstrated to predict coronary artery occlusion in patients with normal ECG and troponin levels18 but this has yet to become widely available, and reported low specificity19 may raise problems of management of the false-positive result.…”

Comparing two noninvasive techniques for detecting coronary artery disease

“…[1][2][3][4][5][7][8][9][10][11][12][13] The results from all studies in this review agreed that the CCTA with a negative or low calcium score was a superior noninvasive diagnostic test for predicting CAD in low-to intermediate-risk patients. [1][2][3][4][5][7][8][9][10][11][12][13] The results from all studies in this review agreed that the CCTA with a negative or low calcium score was a superior noninvasive diagnostic test for predicting CAD in low-to intermediate-risk patients.…”

“…1 CACS of greater than zero had a sensitivity of 95% and specificity of 31%; the CACS of 100 had a sensitivity of 70% and specificity of 71%. 4 Fernandez-Friera and colleagues conducted a prospective study with 225 patients using CACS to identify CAD in low-to intermediate-risk patients presenting to the ED for ACS. The study identified CACS as a strong predictor of the prognosis of patients with CAD, although with a zero calcium score, the CACS could predict major adverse cardiovascular events in low-risk patients.…”

“…The patient is given I.V. 4 The advantage of the CACS is that it requires no patient preparation. 2 Advantages of CCTA include its rapidity (it can be performed in less than a minute); it lets the healthcare provider evaluate the cardiac chambers, myocardium, and valves; it can detect soft plaques; and compared to cardiac catheterization, it's less risky and uncomfortable and recovery time is shorter.…”

A Systematic Review of the Predictive Value of a Coronary Computed Tomography Angiography as Compared With Coronary Calcium Scoring in Alternative Noninvasive Technique in Detecting Coronary Artery Disease and Evaluating Acute Coronary Syndrome in an Acute Care Setting

“…4 The advantage of the CACS is that is requires no patient preparation. Zero is a normal CACS; less than 10 is a low score; 10 to 399 is an intermediate score; and greater than 400 is considered a high score.…”