title: Predictive value of zero calcium score and low-end percentiles for the presence of significant coronary artery stenosis in stable patients with suspected coronary artery disease.
abstract: OBJECTIVE
  To prospectively investigate the predictive value of a zero calcium score (CS) value as well as age- and sex-adjusted low-end CS percentiles for the presence of significant coronary artery stenosis in stable patients with suspected coronary artery disease (CAD).
  
  
  METHODS
  In total, 87 consecutive stable patients with suspected CAD were prospectively enrolled in this study (33 women; 66 ± 10 years). All patients underwent non-enhanced CT for calcium scoring (CSCT) and contrast-enhanced coronary CT angiography (cCTA). Invasive coronary angiography (ICA) served as the reference standard in all patients. Diagnostic performance for the presence of significant stenosis (≥ 50% diameter) was calculated separately for CS in comparison to cCTA and ICA.
  
  
  RESULTS
  ICA identified significant stenosis in 56/87 patients (64%). The mean CS was 571 ± 599. On a per patient based analysis, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for patients with a zero CS were 98.5%, 18.2%, 78.0% and 80.0%, respectively, compared to cCTA and 100%, 16.1%, 68.3% and 100%, respectively, compared to ICA. Low-end age- and sex-adjusted percentiles derived from asymptomatic Caucasian populations showed results comparable to a CS of zero.
  
  
  CONCLUSIONS
  The prevalence of significant coronary artery stenosis is low in stable patients with suspected CAD and a CS of zero but also in patients below certain low-end age- and sex-adjusted percentile ranks. Thus, CS should be used as a gatekeeper prior to further diagnostic procedures in these patients. A CS value below certain age- and sex-adjusted percentile ranks seems to be of identical diagnostic value to a CS of zero in stable patients.
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Heidelberg University, Mannheim, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Vogler
authors.forename: M
authors.initials: M
authors.lastname: Meyer
authors.forename: C
authors.initials: C
authors.lastname: Fink
authors.forename: U J
authors.initials: UJ
authors.lastname: Schoepf
authors.forename: S O
authors.initials: SO
authors.lastname: Schönberg
authors.forename: T
authors.initials: T
authors.lastname: Henzler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002114:Calcinosis / Q000000981:diagnostic imaging*; D006328:Cardiac Catheterization / Q000379:methods*; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods*; D003287:Contrast Media / Q000008:administration & dosage*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007479:Iopamidol / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011829:Radiation Dosage; D012680:Sensitivity and Specificity; D012737:Sex Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol