title: Ruling out coronary artery disease in women with atypical chest pain: results of calcium score combined with coronary computed tomography angiography and associated radiation exposure.
abstract: BACKGROUND
  To assess the presence of coronary artery disease (CAD) in women with atypical chest pain with low or intermediate risk for significant CAD by means of calcium scoring (CaSc) combined with coronary computed tomography angiography (CCTA) and to estimate the equivalent radiation dose in women.
  
  
  METHODS
  From December 2011 until July 2013, all consecutively performed cardiac CTs in women with atypical chest pain were included prospectively in the present study. Both CaSc and CCTA were obtained by a dual source flying focal spot 2×64 slice Somatom Definition Flash. Absence of CAD was defined as CaSc 0 and absence of noncalcified plaques. Presence of CAD was determined as CaSc>0 and/or presence of noncalcified plaques. The impact on patient management was also scored within our patient cohort.
  
  
  RESULTS
  A total of 1033 procedures in 1014 women (mean age 59±10 years; mean BMI 26±8) were analyzed. In 520 (51%) women, CAD was absent. In 494 (49%) women, CAD was diagnosed, and in this subgroup the mean CaSc was 137±229. Thirty-seven (7%) of 494 women with CAD showed only noncalcified plaques. The mean equivalent radiation dose for the cardiac CTs of 1014 women was 2.2±1.6 mSv.
  
  
  CONCLUSIONS
  Combined CaSc and CCTA excludes CAD in approximately 50% of women with atypical chest pain, and delivers a modest radiation dose of 2.2±1.6 mSv. CCTA has a substantial impact on patient management and can thus be advocated as first diagnostic tool in excluding CAD in women with atypical chest pain in terms of latest generation equipment with emphasize on radiation reduction techniques.
authors: Department of Cardiac Imaging, Medical Center Alkmaar , Alkmaar, The Netherlands .
authors: Friso M
authors: FM
authors: van der Zant
authors: Department of Cardiac Imaging, Medical Center Alkmaar , Alkmaar, The Netherlands .
authors: Maurits
authors: M
authors: Wondergem
authors: Department of Cardiac Imaging, Medical Center Alkmaar , Alkmaar, The Netherlands .
authors: Sergiy V
authors: SV
authors: Lazarenko
authors: Department of Cardiac Imaging, Medical Center Alkmaar , Alkmaar, The Netherlands .
authors: Remy W F
authors: RW
authors: Geenen
authors: Department of Cardiac Imaging, Medical Center Alkmaar , Alkmaar, The Netherlands .
authors: Victor A
authors: VA
authors: Umans
authors: Department of Cardiac Imaging, Medical Center Alkmaar , Alkmaar, The Netherlands .
authors: Jan-Hein
authors: JH
authors: Cornel
authors: Department of Cardiac Imaging, Medical Center Alkmaar , Alkmaar, The Netherlands .
authors: Remco J J
authors: RJ
authors: Knol
mesh_terms: D000328:Adult; D000368:Aged; D002118:Calcium / Q000378:metabolism*; D002637:Chest Pain; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D000069079:Radiation Exposure / Q000009:adverse effects*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D002118:Calcium