title: Development and validation of a predictive screening tool for uninterpretable coronary CT angiography results.
abstract: BACKGROUND
  Coronary CT angiography (CCTA) is an excellent tool for noninvasive assessment of coronary arteries in low- to intermediate-risk individuals. However, the accuracy of CCTA heavily depends on image quality. Our objective was to develop and validate a tool to predict pre-CCTA risk of obtaining an uninterpretable result in symptomatic patients.
  
  
  RESULTS
  Among 8585 symptomatic patients, we identified variables independently associated with the presence of at least 1 uninterpretable major coronary segment to create the uninterpretable risk score (URS). This risk score was developed using both clinical variables and patient variables acquired at the time the CCTA was performed (heart rate and coronary calcium). The URS was then prospectively validated among an additional 915 symptomatic patients. The URS was predictive of uninterpretable results in both the development and the validation cohorts. For every 4-point increase in the URS (range, 0 to 12), the rate of at least 1 uninterpretable coronary segment per 100 CCTA studies increased ≈1.5 fold. Increased heart rate and coronary artery calcium score were predictive of uninterpretable CCTA study results. Uninterpretable results were associated with 3-month outcomes in the development cohort.
  
  
  CONCLUSIONS
  The URS can categorize patients who are likely to have at least 1 uninterpretable major coronary segment on CCTA. This may aid in appropriate patient selection for CCTA and avoiding radiation exposure in those likely to have an uninterpretable study. Clinical Trial Registration- URL: http:///www.clinicaltrials.gov. Unique identifier: NCT00640068.
authors.affiliation: Department of Cardiovascular Medicine, Genesys Regional Medical Center/Ascension Health, Grand Blanc, MI 48430, USA. tvanhecke@gmail.com
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Vanhecke
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Madder
authors.forename: James E
authors.initials: JE
authors.lastname: Weber
authors.forename: Lawrence F
authors.initials: LF
authors.lastname: Bielak
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Peyser
authors.forename: Kavitha M
authors.initials: KM
authors.lastname: Chinnaiyan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000639:trends*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D014481:United States; D055815:Young Adult