Objectives: The aim of the study was to compare the coronary artery calcium score (CACS) and computed tomography coronary angiography (CTCA) for the assessment of non-obstructive/obstructive coronary artery disease (CAD) in high-risk asymptomatic subjects. Methods: Two hundred and thirteen consecutive asymptomatic subjects (113 male; mean age 53.6 ± 12.4 years) with more than one risk factor and an inconclusive or unfeasible non-invasive stress test result underwent CACS and CTCA in an outpatient setting. All patients underwent conventional coronary angiography (CAG). Data from CACS (threshold for positive image: Agatston score 1/100/1,000) and CTCA were compared with CAG regarding the degree of CAD (non-obstructive/obstructive; </≥50% lumen reduction). Results: The mean calcium score was 151 ± 403 and the prevalence of obstructive CAD was 17% (8% one-vessel and 10% two-vessel disease). Per-patient sensitivity, specificity, positive and negative predictive values of CACS were: 97%, 75%, 45%, and 100%, respectively (Agatston ≥1); 73%, 90%, 60%, and 94%, respectively (Agatston ≥100); 30%, 98%, 79%, and 87%, respectively (Agatston ≥1,000). Per-patient values for CTCA were 100%, 98%, 97%, and 100%, respectively (p < 0.05). CTCA detected 65% prevalence of all CAD (48% non-obstructive), while CACS detected 37% prevalence of all CAD (21% non-obstructive) (p < 0.05). Conclusion: CACS proved inadequate for the detection of obstructive and non-obstructive CAD compared with CTCA. CTCA has a high diagnostic accuracy for the detection of non-obstructive and obstructive CAD in high-risk asymptomatic patients with inconclusive or unfeasible stress test results.

Asymptomatic, Computed tomography coronary angiography, Conventional coronary angiography, Coronary artery disease, Coronary calcium score, Non-obstructive CAD, Primary prevention
dx.doi.org/10.1007/s00330-009-1612-2, hdl.handle.net/1765/28180
European Radiology: journal of the European Congress of Radiology
Erasmus MC: University Medical Center Rotterdam

Cademartiri, F, Maffei, E, Palumbo, A, Seitun, S, Martini, C, Tedeschi, C, … Krestin, G.P. (2010). Coronary calcium score and computed tomography coronary angiography in high-risk asymptomatic subjects: Assessment of diagnostic accuracy and prevalence of non-obstructive coronary artery disease. European Radiology: journal of the European Congress of Radiology, 20(4), 846–854. doi:10.1007/s00330-009-1612-2