title: Detection of silent coronary artery disease by computed tomographic scan: coronary artery calcium versus noninvasive coronary angiography.
abstract: OBJECTIVE
  Multislice computerized tomographic scan can identify coronary artery disease (CAD) with quantification of coronary artery calcium (CAC) and computed tomographic coronary angiography (CTA). The utility of CAC in comparison with CTA in asymptomatic patients has not been assessed.
  
  
  METHODS
  Patients with risk factors for CAD, who were referred for screening, were studied using CAC and CTA, using a Phillips Mx8000 IDT 16 multislice computed tomographic scanner.
  
  
  RESULTS
  Three hundred and forty-seven patients with a mean age of 55 years, 89.9% male, were included. CAC showed calcium deposits in 171 patients (49.3%) whereas CTA found lesions in 157 patients (45%). CAC correctly identified 309 patients with respect to CTA (presence of any disease) implying a test accuracy of 89%, sensitivity of 85%, specificity of 86%, and negative predictive value of 93%. Obstructive lesions were shown by 7.7% of the patients (stenosis >50%), 22% of the patients with CAC greater than 400, and 2.8% of the patients with CAC of 0. To undergo a CTA scan after CAC permits to re-classify 11% of the patients on the basis of CTA.
  
  
  CONCLUSIONS
  CAC, in detecting silent CAD, seems to be a good alternative to CTA, in these asymptomatic patients, but CAC is inappropriate to predict the presence or absence of a coronary artery obstruction.
authors.affiliation: Department of Internal Medicine and Preventative Medicine, Sagrat Cor University Hospital, Barcelona, Spain. cesar.morcillo@cimaclinic.com
authors.forename: Cèsar
authors.initials: C
authors.lastname: Morcillo Serra
authors.forename: Joan M
authors.initials: JM
authors.lastname: Roca
authors.forename: Josep
authors.initials: J
authors.lastname: Masip
authors.forename: Jordi
authors.initials: J
authors.lastname: Delás
authors.forename: Mark
authors.initials: M
authors.lastname: Rennie
authors.forename: Anna
authors.initials: A
authors.lastname: Schembari
authors.forename: Yolanda
authors.initials: Y
authors.lastname: López-Perna
authors.forename: Siraj
authors.initials: S
authors.lastname: Bechich
mesh_terms: D058070:Asymptomatic Diseases; D002114:Calcinosis / Q000000981:diagnostic imaging*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013030:Spain; D014057:Tomography, X-Ray Computed