Diagnostic Accuracy of Coronary Calcium Score Less than 100 in Excluding Coronary Artery Disease.
BACKGROUND
Coronary artery calcium score (CACS) is a quantitative assessment of calcifications and an established predictor of cardiovascular events.


OBJECTIVE
In this study, we evaluated the diagnostic accuracy, negative predictive value (NPV), positive predictive value (PPV), specificity and sensitivity of CACS less than 100 in predicting significant coronary artery stenosis in patients with risk of coronary artery disease (CAD) in a vessel-based analysis.


METHODS
A cross sectional study was carried out on a study population of 2527 consecutive stable patients with symptoms suggestive of CAD who were referred for coronary computed tomographic angiography (CCTA). We performed 1343 studies with 256 slice machine in Shahid Rajaee hospital and the other studies were carried out with 64 slice machine in Imam Khomeini hospital and the calcium score was quantified according to the Agatston method.


RESULTS
At the cutoff point of 100 for coronary calcium scoring, there was high specificity (87%), high sensitivity (79%), high efficiency (84%), high PPV (79%), and high NPV (87%) in the diagnosis of significant stenosis in the whole heart. The frequency of zero calcium scoring was 59% in normal or nonsignificant stenosis and 7.6% in significant stenosis in the whole heart. Calcium scoring increased with greater severity of the arterial stenosis (P values < 0.001).


CONCLUSIONS
We conclude that coronary calcium scoring provided useful information in the management of patients. In CACS less than 100, it has a NPV of 87% in excluding significant stenosis in patients with the risk of CAD but it does not have enough diagnostic accuracy for surely excluding coronary stenosis, so we should perform a combination of CACS and coronary CT angiography for patients.
Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.
Reza
R
Hanifehpour
Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran; Department of Radiology, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Marzieh
M
Motevalli
Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.
Hossein
H
Ghanaati
Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.
Mona
M
Shahriari
Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.
Mounes
M
Aliyari Ghasabeh
Calcium Score; Coronary Artery Disease; Diagnostic Efficacy; Multidetector Computed Tomography
N Engl J Med. 2008 Mar 27;358(13):1336-45
18367736
J Am Coll Cardiol. 1990 Mar 15;15(4):827-32
2407762
J Am Coll Cardiol. 2007 Sep 4;50(10 ):953-60
17765122
J Am Coll Cardiol. 2010 Feb 16;55(7):627-34
20170786
Iran Red Crescent Med J. 2014 Dec 30;16(12):e26010
25763246
Acad Radiol. 2012 Nov;19(11):1316-23
22897947
Kardiol Pol. 2006 Oct;64(10 ):1073-9; discussion 1080-1
17089239
Am J Med. 1984 Feb 27;76(2A):4-12
6702862
Med Image Comput Comput Assist Interv. 2010;13(Pt 1):484-92
20879266
Am J Med. 2008 Aug;121(8):715-25
18691486
Eur J Radiol. 2006 Nov;60(2):279-86
16887313
J Am Coll Cardiol. 2007 May 8;49(18):1860-70
17481445
J Cardiovasc Comput Tomogr. 2009 Mar-Apr;3(2):117-21
19332343
Med J Aust. 2012 Mar 5;196 (4):246-9
22409689
Cardiology. 2001;95(4):183-9
11585993
Radiology. 2013 Oct;269(1):77-83
23788718
Circ Cardiovasc Imaging. 2011 Jan;4(1):16-23
20884832
Eur Radiol. 2010 Jan;20(1):81-7
19657651
Int J Cardiol. 2011 Apr 1;148(1):e16-8
19324431
Circulation. 2005 Jul 26;112(4):572-7
16009800