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European Radiology
Published in: European Radiology 4/2010

01-04-2010 | Cardiac

Coronary calcium score and computed tomography coronary angiography in high-risk asymptomatic subjects: assessment of diagnostic accuracy and prevalence of non-obstructive coronary artery disease

Authors: Filippo Cademartiri, Erica Maffei, Alessandro Palumbo, Sara Seitun, Chiara Martini, Carlo Tedeschi, Ludovico La Grutta, Massimo Midiri, Annick C. Weustink, Nico R. Mollet, Gabriel P. Krestin

Published in: European Radiology | Issue 4/2010

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Abstract

Objectives

The aim of the study was to compare the coronary artery calcium score (CACS) and computed tomography coronary angiography (CTCA) for the assessment of non-obstructive/obstructive coronary artery disease (CAD) in high-risk asymptomatic subjects.

Methods

Two hundred and thirteen consecutive asymptomatic subjects (113 male; mean age 53.6 ± 12.4 years) with more than one risk factor and an inconclusive or unfeasible non-invasive stress test result underwent CACS and CTCA in an outpatient setting. All patients underwent conventional coronary angiography (CAG). Data from CACS (threshold for positive image: Agatston score 1/100/1,000) and CTCA were compared with CAG regarding the degree of CAD (non-obstructive/obstructive; </≥50% lumen reduction).

Results

The mean calcium score was 151 ± 403 and the prevalence of obstructive CAD was 17% (8% one-vessel and 10% two-vessel disease). Per-patient sensitivity, specificity, positive and negative predictive values of CACS were: 97%, 75%, 45%, and 100%, respectively (Agatston ≥1); 73%, 90%, 60%, and 94%, respectively (Agatston ≥100); 30%, 98%, 79%, and 87%, respectively (Agatston ≥1,000). Per-patient values for CTCA were 100%, 98%, 97%, and 100%, respectively (p < 0.05). CTCA detected 65% prevalence of all CAD (48% non-obstructive), while CACS detected 37% prevalence of all CAD (21% non-obstructive) (p < 0.05).

Conclusion

CACS proved inadequate for the detection of obstructive and non-obstructive CAD compared with CTCA. CTCA has a high diagnostic accuracy for the detection of non-obstructive and obstructive CAD in high-risk asymptomatic patients with inconclusive or unfeasible stress test results.
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Metadata
Title
Coronary calcium score and computed tomography coronary angiography in high-risk asymptomatic subjects: assessment of diagnostic accuracy and prevalence of non-obstructive coronary artery disease
Authors
Filippo Cademartiri
Erica Maffei
Alessandro Palumbo
Sara Seitun
Chiara Martini
Carlo Tedeschi
Ludovico La Grutta
Massimo Midiri
Annick C. Weustink
Nico R. Mollet
Gabriel P. Krestin
Publication date
01-04-2010
Publisher
Springer-Verlag
Published in
European Radiology / Issue 4/2010
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-009-1612-2

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