title: Coronary calcium score as gatekeeper for 64-slice computed tomography coronary angiography in patients with chest pain: per-segment and per-patient analysis.
abstract: We sought to investigate the performance of 64-slice CT in symptomatic patients with different coronary calcium scores. Two hundred patients undergoing 64-slice CT coronary angiography for suspected coronary artery disease were enrolled into five groups based on Agatston calcium score using the Mayo Clinic risk stratification: group 1: score 0, group 2: score 1-10, group 3: score 11-100, group 4: score 101-400, and group 5: score > 401. Diagnostic accuracy for the detection of significant (>/=50% lumen reduction) coronary artery stenosis was assessed on a per-segment and per-patient base using quantitative coronary angiography as the gold standard. For groups 1 through 5, sensitivity was 97, 96, 91, 90, 92%, and specificity was 99, 98, 96, 88, 90%, respectively, on a per-segment basis. On a per-patient basis, the best diagnostic performance was obtained in group 1 (sensitivity 100% and specificity 100%) and group 5 (sensitivity 95% and specificity 100%). Progressively higher coronary calcium levels affect diagnostic accuracy of CT coronary angiography, decreasing sensitivity and specificity on a per-segment base. On a per-patient base, the best results in terms of diagnostic accuracy were obtained in the populations with very low and very high cardiovascular risk.
authors.affiliation: Department of Radiology and Cardiology, Azienda Ospedaliero-Universitaria di Parma, Non-Invasive Cardiovascular Imaging, Piastra Tecnica - Piano 0, Via Gramsci, 14, Parma 43100, Italy.
authors.forename: Anselmo Alessandro
authors.initials: AA
authors.lastname: Palumbo
authors.forename: Erica
authors.initials: E
authors.lastname: Maffei
authors.forename: Chiara
authors.initials: C
authors.lastname: Martini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Di Tanna
authors.forename: Elena
authors.initials: E
authors.lastname: Berti
authors.forename: Roberto
authors.initials: R
authors.lastname: Grilli
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Casolo
authors.forename: Valerio
authors.initials: V
authors.lastname: Brambilla
authors.forename: Marcella
authors.initials: M
authors.lastname: Cerrato
authors.forename: Antonio
authors.initials: A
authors.lastname: Rotondo
authors.forename: Annick C
authors.initials: AC
authors.lastname: Weustink
authors.forename: Nico R A
authors.initials: NR
authors.lastname: Mollet
authors.forename: Filippo
authors.initials: F
authors.lastname: Cademartiri
mesh_terms: D000465:Algorithms; D002114:Calcinosis / Q000000981:diagnostic imaging*; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*