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.
OBJECTIVE
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; </>or=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 >or=1); 73%, 90%, 60%, and 94%, respectively (Agatston >or=100); 30%, 98%, 79%, and 87%, respectively (Agatston >or=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).


CONCLUSIONS
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.
Cademartiri
Filippo
F
Department of Radiology and Cardiology, Azienda Ospedaliero-Universitaria, Parma, Italy. filippocademartiri@hotmail.com
Maffei
Erica
E
Palumbo
Alessandro
A
Seitun
Sara
S
Martini
Chiara
C
Tedeschi
Carlo
C
La Grutta
Ludovico
L
Midiri
Massimo
M
Weustink
Annick C
AC
Mollet
Nico R
NR
Krestin
Gabriel P
GP
D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D055815:Young Adult