Coronary artery diseaseImpact of Clinical Presentation and Pretest Likelihood on the Relation Between Calcium Score and Computed Tomographic Coronary Angiography
Section snippets
Methods
The study population consisted of patients with suspected CAD who were clinically referred for further cardiac assessment because of chest pain. The included patients underwent CCS scanning and CTA. Exclusion criteria were cardiac arrhythmias, renal insufficiency (defined as glomerular filtration rate <30 ml/min), known hypersensitivity to iodine contrast media, severe claustrophobia, and pregnancy. In addition, patients with an uninterpretable CT angiographic examination were excluded.
Results
The study population consisted of 602 patients presenting with chest pain who had undergone CCS and CTA. In 26 of these patients (4.3%), CT angiographic examination was uninterpretable because of the presence of motion artifacts, increased noise owing to a high body mass index, and breathing. After exclusion of these patients, 576 remained for further analysis. Baseline characteristics of the patient population are presented in Table 1.
Median CCS of the study population was 7 (25th to 75th
Discussion
The main finding of the present study is that the relation between CCS and CTA is strongly influenced by clinical presentation and pretest likelihood in patients presenting with chest pain. In each CCS category, prevalence of significant CAD on CT angiogram increased proportional to the severity of clinical presentation and pretest likelihood. Clinical presentation and pretest likelihood should therefore be taken into account when using CCS as a gatekeeper for CTA.
Several previous studies have
References (14)
- et al.
The absence of coronary calcification does not exclude obstructive coronary artery disease or the need for revascularization in patients referred for conventional coronary angiography
J Am Coll Cardiol
(2010) - et al.
Multislice spiral computed tomographic angiography of coronary arteries in patients with suspected coronary artery disease: an effective filter before catheter angiography?
Am Heart J
(2005) - et al.
Comparison of the value of coronary calcium detection to computed tomographic angiography and exercise testing in patients with chest pain
Am J Cardiol
(2009) - et al.
Prevalence and extent of obstructive coronary artery disease in patients with zero or low calcium score undergoing 64-slice cardiac multidetector computed tomography for evaluation of a chest pain syndrome
Am J Cardiol
(2007) A clinically relevant classification of chest discomfort
J Am Coll Cardiol
(1983)- et al.
Influence of symptomatic status on the prevalence of obstructive coronary artery disease in patients with zero calcium score
Atherosclerosis
(2008) - et al.
Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease
N Engl J Med
(1979)
Cited by (0)
Dr. van Werkhoven is financially supported by a research grant from the Netherlands Society of Cardiology, Utrecht, The Netherlands. Dr. Boogers is supported Grant 2006T102 from the Dutch Heart Foundation, Utrecht, The Netherlands. Dr. Bax has research grants from Medtronic, Tolochenaz, Switzerland; Boston Scientific, Maastricht, The Netherlands; BMS Medical Imaging, N. Billerica, Massachusetts; St. Jude Medical, Veenendaal, The Netherlands; Biotronik, Berlin, Germany; GE Healthcare, St. Giles, United Kingdom; and Edwards Lifesciences, Saint-Prex, Switzerland.
- †
Dr. van Werkhoven and Ms. de Boer contributed equally to this work.