title: Distribution of coronary calcifications in patients with suspected coronary heart disease.
abstract: BACKGROUND
  Coronary calcifications are a marker of coronary atherosclerosis. The role of coronary calcium scoring (CS) as part of the initial evaluation of patients with suspected coronary heart disease (CHD) is controversially discussed. The primary goal of this study was to characterize the coronary calcium distribution in this particular patient population. In a second step, we aimed to establish a possible clinical implication using CS for the diagnosis of CHD.
  
  
  METHODS
  Calcium scoring procedure was performed by either using a multidetector or a dual-source computed tomographic scanner. All patients underwent invasive coronary angiography (ICA) as the current criterion standard for CHD detection. A total of 4,137 (2,780 men, mean age 60.5 ± 12.4 years) consecutive patients were included.
  
  
  RESULTS
  Mean CS was 288 ± 446 (range 0-5,252). Overall coronary artery calcifications significantly increased with patients' age. In 2,048 patients (mean CS 101 ± 239, range 0-5252), significant CHD (≥50% stenosis) was excluded by ICA (1,939 patients without calcifications). In remaining 2,089 patients (51%, mean CS 607 ± 821, range 0-5,252), significant CHD was documented leading to intervention in 732 patients. A threshold of zero calcifications (existence of calcified tissue) had the best overall sensitivity and negative predictive value with 99%. Overall specificity with 34% and overall positive predictive value with 24% were rather low.
  
  
  CONCLUSIONS
  Coronary calcium scoring is able to exclude significant CHD in patients with suspected CHD with a high negative predictive value and, therefore, possibly reduce the number of invasive diagnostic examinations. Because of the low specificity and positive predictive value, CS cannot be used to indicate ICA.
authors.affiliation: University of Munich, Department of Cardiology, Campus Grosshadern, Munich, Germany. Electronic address: franz.ziegler@med.uni-muenchen.de.
authors.forename: Franz
authors.initials: F
authors.lastname: von Ziegler
authors.affiliation: University of Munich, Department of Cardiology, Campus Grosshadern, Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Greif
authors.affiliation: University of Munich, Department of Cardiology, Campus Grosshadern, Munich, Germany.
authors.forename: Janine
authors.initials: J
authors.lastname: Tittus
authors.affiliation: University of Munich, Department of Cardiology, Campus Grosshadern, Munich, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Schenzle
authors.affiliation: University of Munich, Department of Clinical Radiology, Campus Grosshadern, Munich, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Becker
authors.affiliation: University of Munich, Department of Cardiology, Campus Grosshadern, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Becker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000175:diagnosis*; D017023:Coronary Angiography / Q000379:methods*; D003327:Coronary Disease / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D055815:Young Adult