Coronary calcium score as gatekeeper for 64-slice computed tomography coronary angiography in patients with chest pain: per-segment and per-patient analysis.
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.
Palumbo
Anselmo Alessandro
AA
Department of Radiology and Cardiology, Azienda Ospedaliero-Universitaria di Parma, Non-Invasive Cardiovascular Imaging, Piastra Tecnica - Piano 0, Via Gramsci, 14, Parma 43100, Italy.
Maffei
Erica
E
Martini
Chiara
C
Tarantini
Giuseppe
G
Di Tanna
Gian Luca
GL
Berti
Elena
E
Grilli
Roberto
R
Casolo
Giancarlo
G
Brambilla
Valerio
V
Cerrato
Marcella
M
Rotondo
Antonio
A
Weustink
Annick C
AC
Mollet
Nico R A
NR
Cademartiri
Filippo
F
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*