Incremental value of the CT coronary calcium score for the prediction of coronary artery disease.
OBJECTIVE
To validate published prediction models for the presence of obstructive coronary artery disease (CAD) in patients with new onset stable typical or atypical angina pectoris and to assess the incremental value of the CT coronary calcium score (CTCS).


METHODS
We searched the literature for clinical prediction rules for the diagnosis of obstructive CAD, defined as ≥50% stenosis in at least one vessel on conventional coronary angiography. Significant variables were re-analysed in our dataset of 254 patients with logistic regression. CTCS was subsequently included in the models. The area under the receiver operating characteristic curve (AUC) was calculated to assess diagnostic performance.


RESULTS
Re-analysing the variables used by Diamond & Forrester yielded an AUC of 0.798, which increased to 0.890 by adding CTCS. For Pryor, Morise 1994, Morise 1997 and Shaw the AUC increased from 0.838 to 0.901, 0.831 to 0.899, 0.840 to 0.898 and 0.833 to 0.899. CTCS significantly improved model performance in each model.


CONCLUSIONS
Validation demonstrated good diagnostic performance across all models. CTCS improves the prediction of the presence of obstructive CAD, independent of clinical predictors, and should be considered in its diagnostic work-up.
Genders
Tessa S S
TS
Department of Epidemiology, Erasmus University Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands.
Pugliese
Francesca
F
Mollet
Nico R
NR
Meijboom
W Bob
WB
Weustink
Annick C
AC
van Mieghem
Carlos A G
CA
de Feyter
Pim J
PJ
Hunink
M G Myriam
MG
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis* / Q000000981:diagnostic imaging; D019540:Area Under Curve; D015992:Body Mass Index; D002118:Calcium / Q000032:analysis* / Q000378:metabolism; D017023:Coronary Angiography / Q000379:methods; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D015203:Reproducibility of Results; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
D002118:Calcium