title: Measurement of coronary calcium scores or exercise testing as initial screening tool in asymptomatic subjects with ST-T changes on the resting ECG: an evaluation study.
abstract: BACKGROUND
  Asymptomatic subjects at intermediate coronary risk may need diagnostic testing for risk stratification. Both measurement of coronary calcium scores and exercise testing are well established tests for this purpose. However, it is not clear which test should be preferred as initial diagnostic test. We evaluated the prevalence of documented coronary artery disease (CAD) according to calcium scores and exercise test results.
  
  
  METHODS
  Asymptomatic subjects with ST-T changes on a rest ECG were selected from the population based PREVEND cohort study and underwent measurement of calcium scores by electron beam tomography and exercise testing. With calcium scores > or =10 or a positive exercise test, myocardial perfusion imaging (MPS) or coronary angiography (CAG) was recommended. The primary endpoint was documented obstructive CAD (>/=50% stenosis).
  
  
  RESULTS
  Of 153 subjects included, 149 subjects completed the study protocol. Calcium scores > or =400, 100-399, 10-99 and <10 were found in 16, 29, 18 and 86 subjects and the primary endpoint was present in 11 (69%), 12 (41%), 0 (0%) and 1 (1%) subjects, respectively. A positive, nondiagnostic and negative exercise test was present in 33, 27 and 89 subjects and the primary endpoint was present in 13 (39%), 5 (19%) and 6 (7%) subjects, respectively. Receiver operator characteristics analysis showed that the area under the curve, as measure of diagnostic yield, of 0.91 (95% CI 0.84-0.97) for calcium scores was superior to 0.74 (95% CI 0.64-0.83) for exercise testing (p = 0.004).
  
  
  CONCLUSIONS
  Measurement of coronary calcium scores is an appropriate initial non-invasive test in asymptomatic subjects at increased coronary risk.
authors.affiliation: Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, The Netherlands. c.a.geluk@thorax.umcg.nl
authors.forename: Christiane A
authors.initials: CA
authors.lastname: Geluk
authors.forename: Riksta
authors.initials: R
authors.lastname: Dikkers
authors.forename: Jan A
authors.initials: JA
authors.lastname: Kors
authors.forename: René A
authors.initials: RA
authors.lastname: Tio
authors.forename: Riemer H J A
authors.initials: RH
authors.lastname: Slart
authors.forename: Rozemarijn
authors.initials: R
authors.lastname: Vliegenthart
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.forename: Tineke P
authors.initials: TP
authors.lastname: Willems
authors.forename: Paul E
authors.initials: PE
authors.lastname: de Jong
authors.forename: Wiek H
authors.initials: WH
authors.lastname: van Gilst
authors.forename: Matthijs
authors.initials: M
authors.lastname: Oudkerk
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
mesh_terms: D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed