title: Coronary computed tomography angiography and calcium scoring in routine clinical practice for identification of patients who require revascularization.
abstract: BACKGROUND
  The predictive value of CCTA to predict coronary artery disease is high in particular in the absence of coronary calcification. However, the consideration of both CCTA and the calcium score, in addition to the risk factors to determine the indication for coronary revascularization, has not been yet studied.
  
  
  METHODS
  This study included 2302 patients (mean age: 60±9.8 years, 46% men), without known coronary artery disease (CAD), who underwent 320-row CCTA. Logistic regression, c-statistic and net reclassification improvement (NRI) were used to assess the role of coronary artery calcium score (CACS) in predicting revascularization after CCTA.
  
  
  RESULTS
  The revascularization rates were 0.75% in patients with a CACS of 0, and there were no adverse events during the follow-up period. The revascularization rates were 3.3% in patients with a CACS of 1-99, 15.4% in patients with a CACS of 100-399, 25.6% in patients with a CACS of 400-999, and 42.4% in patients with a CACS≥1000. The crude and adjusted odds ratios (95% confidence interval) for revascularization per CACS group category were 2.89 (2.53-2.3) and 2.71 (2.33-3.15), respectively; the area under the ROC curve (AUC) was 0.85 (0.83-0.88). The addition of CACS to conventional risk factors improved the accuracy of risk prediction model for revascularization (AUC 0.74 vs 0.63, P=0.001), but it did not reclassify a substantial proportion of patients with positive CACS to risk categories (NRI=-0.023, P=0.66).
  
  
  CONCLUSIONS
  The 320-row CCTA might rule out CAD in low- to intermediate-risk patients. However, its accuracy in identifying patients who require revascularization is limited. The CACS added to the conventional risk factors did not improve the identification of patients who require revascularization.
authors.affiliation: University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark; Aarhus University, Institute for Clinical Medicine, Aarhus, Denmark. Electronic address: graurb@rm.dk.
authors.forename: Grazina
authors.initials: G
authors.lastname: Urbonaviciene
authors.affiliation: University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark.
authors.forename: Christin
authors.initials: C
authors.lastname: Isaksen
authors.affiliation: Aarhus University, Institute for Clinical Medicine, Aarhus, Denmark; Viborg Hospital, Department of Vascular Surgery, Viborg, Denmark.
authors.forename: Sigitas
authors.initials: S
authors.lastname: Urbonavicius
authors.affiliation: University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark.
authors.forename: Jørgen Selmer
authors.initials: JS
authors.lastname: Buhl
authors.affiliation: University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark.
authors.forename: Jane Kirk
authors.initials: JK
authors.lastname: Johansen
authors.affiliation: University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark.
authors.forename: Agnete Hedemann
authors.initials: AH
authors.lastname: Nielsen
authors.affiliation: University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark.
authors.forename: Kirsten Schou
authors.initials: KS
authors.lastname: Nørgaard
authors.affiliation: University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark.
authors.forename: Aage
authors.initials: A
authors.lastname: Nørgaard
authors.affiliation: University Clinic for Development of Innovative Patient Pathways, Silkeborg Hospital, Diagnostic Centre, Silkeborg, Denmark; Aarhus University, Institute for Clinical Medicine, Aarhus, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Frost
mesh_terms: D000368:Aged; D019540:Area Under Curve; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003718:Denmark; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000401:mortality; D015588:Observer Variation; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*
keywords: Calcium scoring; Coronaroscanner; Coronary computed tomography angiography; Hemodynamically significant stenosis; Revascularisation coronaire; Revascularization therapy; Score calcique; Sténose hémodynamiquement significative