Skip to main content
Top
Published in: BMC Cardiovascular Disorders 1/2008

Open Access 01-12-2008 | Research article

The role of coronary artery calcification score in clinical practice

Authors: Lieuwe H Piers, Farah Salachova, Riemer HJA Slart, Rozemarijn Vliegenthart, Riksta Dikkers, Frederique AP Hospers, Hjalmar R Bouma, Clark J Zeebregts, Tineke P Willems, Matthijs Oudkerk, Felix Zijlstra, René A Tio

Published in: BMC Cardiovascular Disorders | Issue 1/2008

Login to get access

Abstract

Background

Coronary artery calcification (CAC) measured by electron-beam computed tomography (EBCT) has been well studied in the prediction of coronary artery disease (CAD). We sought to evaluate the impact of the CAC score in the diagnostic process immediately after its introduction in a large tertiary referral centre.

Methods

598 patients with no history of CAD who underwent EBCT for evaluation of CAD were retrospectively included into the study. Ischemia detection test results (exercise stress test, single photon emission computed tomography or ST segment analysis on 24 hours ECG detection), as well as the results of coronary angiography (CAG) were collected.

Results

The mean age of the patients was 55 ± 11 years (57% male). Patients were divided according to CAC scores; group A < 10, B 10 – 99, C 100 – 399 and D ≥ 400 (304, 135, 89 and 70 patients respectively). Ischemia detection tests were performed in 531 (89%) patients; negative ischemia results were found in 362 patients (183 in group A, 87 in B, 58 in C, 34 in D). Eighty-eight percent of the patients in group D underwent CAG despite negative ischemia test results, against 6% in group A, 16% in group B and 29% in group C. A positive ischemia test was found in 74 patients (25 in group A, 17 in B, 16 in C, 16 in D). In group D 88% (N = 14) of the patients with a positive ischemia test were referred for CAG, whereas 38 – 47% in group A-C.

Conclusion

Our study showed that patients with a high CAC score are more often referred for CAG. The CAC scores can be used as an aid in daily cardiology practice to determine further decision making.
Appendix
Available only for authorised users
Literature
1.
go back to reference Froelicher VF, Thomas MM, Pillow C, Lancaster MC: Epidemiologic study of asymptomatic men screened by maximal treadmill testing for latent coronary artery disease. Am J Cardiol. 1974, 34: 770-776. 10.1016/0002-9149(74)90694-8.CrossRefPubMed Froelicher VF, Thomas MM, Pillow C, Lancaster MC: Epidemiologic study of asymptomatic men screened by maximal treadmill testing for latent coronary artery disease. Am J Cardiol. 1974, 34: 770-776. 10.1016/0002-9149(74)90694-8.CrossRefPubMed
2.
go back to reference McHenry PL, O'Donnell J, Morris SN, Jordan JJ: The abnormal exercise electrocardiogram in apparently healthy men: a predictor of angina pectoris as an initial coronary event during long-term follow-up. Circulation. 1984, 70: 547-551.CrossRefPubMed McHenry PL, O'Donnell J, Morris SN, Jordan JJ: The abnormal exercise electrocardiogram in apparently healthy men: a predictor of angina pectoris as an initial coronary event during long-term follow-up. Circulation. 1984, 70: 547-551.CrossRefPubMed
3.
go back to reference Wexler L, Brundage B, Crouse J, Detrano R, Fuster V, Maddahi J, Rumberger J, Stanford W, White R, Taubert K: Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications. A statement for health professionals from the American Heart Association. Writing Group. Circulation. 1996, 94: 1175-1192.CrossRefPubMed Wexler L, Brundage B, Crouse J, Detrano R, Fuster V, Maddahi J, Rumberger J, Stanford W, White R, Taubert K: Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications. A statement for health professionals from the American Heart Association. Writing Group. Circulation. 1996, 94: 1175-1192.CrossRefPubMed
4.
go back to reference Ross R: The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature. 1993, 362: 801-809. 10.1038/362801a0.CrossRefPubMed Ross R: The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature. 1993, 362: 801-809. 10.1038/362801a0.CrossRefPubMed
5.
go back to reference Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WF, Froelicher VF, Mark DB, Marwick TH, McCallister BD, Thompson PD, Winters WL, Yanowitz FG, Ritchie JL, Gibbons RJ, Cheitlin MD, Eagle KA, Gardner TJ, Garson A, Lewis RP, O'Rourke RA, Ryan TJ: ACC/AHA Guidelines for Exercise Testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol. 1997, 30: 260-311. 10.1016/S0735-1097(97)00150-2.CrossRefPubMed Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WF, Froelicher VF, Mark DB, Marwick TH, McCallister BD, Thompson PD, Winters WL, Yanowitz FG, Ritchie JL, Gibbons RJ, Cheitlin MD, Eagle KA, Gardner TJ, Garson A, Lewis RP, O'Rourke RA, Ryan TJ: ACC/AHA Guidelines for Exercise Testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol. 1997, 30: 260-311. 10.1016/S0735-1097(97)00150-2.CrossRefPubMed
6.
go back to reference Mahmarian JJ, Boyce TM, Goldberg RK, Cocanougher MK, Roberts R, Verani MS: Quantitative exercise thallium-201 single photon emission computed tomography for the enhanced diagnosis of ischemic heart disease. J Am Coll Cardiol. 1990, 15: 318-329.CrossRefPubMed Mahmarian JJ, Boyce TM, Goldberg RK, Cocanougher MK, Roberts R, Verani MS: Quantitative exercise thallium-201 single photon emission computed tomography for the enhanced diagnosis of ischemic heart disease. J Am Coll Cardiol. 1990, 15: 318-329.CrossRefPubMed
7.
go back to reference Weiner DA, Ryan TJ, McCabe CH, Luk S, Chaitman BR, Sheffield LT, Tristani F, Fisher LD: Significance of silent myocardial ischemia during exercise testing in patients with coronary artery disease. Am J Cardiol. 1987, 59: 725-729. 10.1016/0002-9149(87)91081-2.CrossRefPubMed Weiner DA, Ryan TJ, McCabe CH, Luk S, Chaitman BR, Sheffield LT, Tristani F, Fisher LD: Significance of silent myocardial ischemia during exercise testing in patients with coronary artery disease. Am J Cardiol. 1987, 59: 725-729. 10.1016/0002-9149(87)91081-2.CrossRefPubMed
8.
go back to reference Guerci AD, Spadaro LA, Goodman KJ, Lledo-Perez A, Newstein D, Lerner G, Arad Y: Comparison of electron beam computed tomography scanning and conventional risk factor assessment for the prediction of angiographic coronary artery disease. J Am Coll Cardiol. 1998, 32: 673-679. 10.1016/S0735-1097(98)00299-X.CrossRefPubMed Guerci AD, Spadaro LA, Goodman KJ, Lledo-Perez A, Newstein D, Lerner G, Arad Y: Comparison of electron beam computed tomography scanning and conventional risk factor assessment for the prediction of angiographic coronary artery disease. J Am Coll Cardiol. 1998, 32: 673-679. 10.1016/S0735-1097(98)00299-X.CrossRefPubMed
9.
go back to reference Heijenbrok-Kal MH, Fleischmann KE, Hunink MG: Stress echocardiography, stress single-photon-emission computed tomography and electron beam computed tomography for the assessment of coronary artery disease: a meta-analysis of diagnostic performance. Am Heart J. 2007, 154: 415-423. 10.1016/j.ahj.2007.04.061.CrossRefPubMed Heijenbrok-Kal MH, Fleischmann KE, Hunink MG: Stress echocardiography, stress single-photon-emission computed tomography and electron beam computed tomography for the assessment of coronary artery disease: a meta-analysis of diagnostic performance. Am Heart J. 2007, 154: 415-423. 10.1016/j.ahj.2007.04.061.CrossRefPubMed
10.
go back to reference Rumberger JA, Sheedy PF, Breen JF, Schwartz RS: Coronary calcium, as determined by electron beam computed tomography, and coronary disease on arteriogram. Effect of patient's sex on diagnosis. Circulation. 1995, 91: 1363-1367.CrossRefPubMed Rumberger JA, Sheedy PF, Breen JF, Schwartz RS: Coronary calcium, as determined by electron beam computed tomography, and coronary disease on arteriogram. Effect of patient's sex on diagnosis. Circulation. 1995, 91: 1363-1367.CrossRefPubMed
11.
go back to reference Haberl R, Becker A, Leber A, Knez A, Becker C, Lang C, Bruning R, Reiser M, Steinbeck G: Correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: results of 1,764 patients. J Am Coll Cardiol. 2001, 37: 451-457. 10.1016/S0735-1097(00)01119-0.CrossRefPubMed Haberl R, Becker A, Leber A, Knez A, Becker C, Lang C, Bruning R, Reiser M, Steinbeck G: Correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: results of 1,764 patients. J Am Coll Cardiol. 2001, 37: 451-457. 10.1016/S0735-1097(00)01119-0.CrossRefPubMed
12.
go back to reference Geluk CA, Dikkers R, Kors JA, Tio RA, Slart RH, Vliegenthart R, Hillege HL, Willems TP, de Jong PE, van Gilst WH, Oudkerk M, Zijlstra F: Measurement of coronary calcium scores or exercise testing as initial screening tool in asymptomatic subjects with ST-T changes on the resting ECG: an evaluation study. BMC Cardiovasc Disord. 2007, 7: 19-10.1186/1471-2261-7-19.CrossRefPubMedPubMedCentral Geluk CA, Dikkers R, Kors JA, Tio RA, Slart RH, Vliegenthart R, Hillege HL, Willems TP, de Jong PE, van Gilst WH, Oudkerk M, Zijlstra F: Measurement of coronary calcium scores or exercise testing as initial screening tool in asymptomatic subjects with ST-T changes on the resting ECG: an evaluation study. BMC Cardiovasc Disord. 2007, 7: 19-10.1186/1471-2261-7-19.CrossRefPubMedPubMedCentral
13.
go back to reference Mohlenkamp S, Lehmann N, Schmermund A, Pump H, Moebus S, Baumgart D, Seibel R, Gronemeyer DH, Jockel KH, Eberl R: Prognostic value of extensive coronary calcium quantities in symptomatic males – a 5-year follow-up study. Eur Heart J. 2003, 24: 845-854. 10.1016/S0195-668X(02)00826-6.CrossRefPubMed Mohlenkamp S, Lehmann N, Schmermund A, Pump H, Moebus S, Baumgart D, Seibel R, Gronemeyer DH, Jockel KH, Eberl R: Prognostic value of extensive coronary calcium quantities in symptomatic males – a 5-year follow-up study. Eur Heart J. 2003, 24: 845-854. 10.1016/S0195-668X(02)00826-6.CrossRefPubMed
14.
go back to reference Church TS, Levine BD, McGuire DK, Lamonte MJ, Fitzgerald SJ, Cheng YJ, Kimball TE, Blair SN, Gibbons LW, Nichaman MZ: Coronary artery calcium score, risk factors, and incident coronary heart disease events. Atherosclerosis. 2007, 190: 224-231. 10.1016/j.atherosclerosis.2006.02.005.CrossRefPubMed Church TS, Levine BD, McGuire DK, Lamonte MJ, Fitzgerald SJ, Cheng YJ, Kimball TE, Blair SN, Gibbons LW, Nichaman MZ: Coronary artery calcium score, risk factors, and incident coronary heart disease events. Atherosclerosis. 2007, 190: 224-231. 10.1016/j.atherosclerosis.2006.02.005.CrossRefPubMed
15.
go back to reference Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001, 285: 2486-2497. 10.1001/jama.285.19.2486. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001, 285: 2486-2497. 10.1001/jama.285.19.2486.
16.
go back to reference Fletcher GF, Balady G, Froelicher VF, Hartley LH, Haskell WL, Pollock ML: Exercise standards. A statement for healthcare professionals from the American Heart Association. Writing Group. Circulation. 1995, 91: 580-615.CrossRefPubMed Fletcher GF, Balady G, Froelicher VF, Hartley LH, Haskell WL, Pollock ML: Exercise standards. A statement for healthcare professionals from the American Heart Association. Writing Group. Circulation. 1995, 91: 580-615.CrossRefPubMed
17.
go back to reference Cohn PF: Total ischemic burden: pathophysiology and prognosis. Am J Cardiol. 1987, 59: 3C-6C. 10.1016/0002-9149(87)90188-3.CrossRefPubMed Cohn PF: Total ischemic burden: pathophysiology and prognosis. Am J Cardiol. 1987, 59: 3C-6C. 10.1016/0002-9149(87)90188-3.CrossRefPubMed
18.
go back to reference Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti M, Su HT, Van Train KF, Berman DS: Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med. 1995, 36: 2138-2147.PubMed Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti M, Su HT, Van Train KF, Berman DS: Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med. 1995, 36: 2138-2147.PubMed
19.
go back to reference Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R: Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990, 15: 827-832.CrossRefPubMed Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R: Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990, 15: 827-832.CrossRefPubMed
20.
go back to reference He ZX, Hedrick TD, Pratt CM, Verani MS, Aquino V, Roberts R, Mahmarian JJ: Severity of coronary artery calcification by electron beam computed tomography predicts silent myocardial ischemia. Circulation. 2000, 101: 244-251.CrossRefPubMed He ZX, Hedrick TD, Pratt CM, Verani MS, Aquino V, Roberts R, Mahmarian JJ: Severity of coronary artery calcification by electron beam computed tomography predicts silent myocardial ischemia. Circulation. 2000, 101: 244-251.CrossRefPubMed
21.
go back to reference Geluk CA, Dikkers R, Perik PJ, Tio RA, Gotte MJ, Hillege HL, Vliegenthart R, Houwers JB, Willems TP, Oudkerk M, Zijlstra F: Measurement of coronary calcium scores by electron beam computed tomography or exercise testing as initial diagnostic tool in low-risk patients with suspected coronary artery disease. Eur Radiol. 2008, 18: 244-252. 10.1007/s00330-007-0755-2.CrossRefPubMed Geluk CA, Dikkers R, Perik PJ, Tio RA, Gotte MJ, Hillege HL, Vliegenthart R, Houwers JB, Willems TP, Oudkerk M, Zijlstra F: Measurement of coronary calcium scores by electron beam computed tomography or exercise testing as initial diagnostic tool in low-risk patients with suspected coronary artery disease. Eur Radiol. 2008, 18: 244-252. 10.1007/s00330-007-0755-2.CrossRefPubMed
22.
go back to reference Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F, Daly C, de Backer G, Hjemdahl P, Lopez-Sendon J, Marco J, Morais J, Pepper J, Sechtem U, Simoons M, Thygesen K, Priori SG, Blanc JJ, Budaj A, Camm J, Dean V, Deckers J, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo J, Zamorano JL: Guidelines on the management of stable angina pectoris: executive summary: the Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J. 2006, 27: 1341-1381. 10.1093/eurheartj/ehl001.CrossRefPubMed Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F, Daly C, de Backer G, Hjemdahl P, Lopez-Sendon J, Marco J, Morais J, Pepper J, Sechtem U, Simoons M, Thygesen K, Priori SG, Blanc JJ, Budaj A, Camm J, Dean V, Deckers J, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo J, Zamorano JL: Guidelines on the management of stable angina pectoris: executive summary: the Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J. 2006, 27: 1341-1381. 10.1093/eurheartj/ehl001.CrossRefPubMed
23.
go back to reference Rubinshtein R, Gaspar T, Halon DA, Goldstein J, Peled N, Lewis BS: Prevalence and extent of obstructive coronary artery disease in patients with zero or low calcium score undergoing 64-slice cardiac multidetector computed tomography for evaluation of a chest pain syndrome. Am J Cardiol. 2007, 99: 472-475. 10.1016/j.amjcard.2006.08.060.CrossRefPubMed Rubinshtein R, Gaspar T, Halon DA, Goldstein J, Peled N, Lewis BS: Prevalence and extent of obstructive coronary artery disease in patients with zero or low calcium score undergoing 64-slice cardiac multidetector computed tomography for evaluation of a chest pain syndrome. Am J Cardiol. 2007, 99: 472-475. 10.1016/j.amjcard.2006.08.060.CrossRefPubMed
24.
go back to reference Metz LD, Beattie M, Hom R, Redberg RF, Grady D, Fleischmann KE: The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography: a meta-analysis. J Am Coll Cardiol. 2007, 49: 227-327. 10.1016/j.jacc.2006.08.048.CrossRefPubMed Metz LD, Beattie M, Hom R, Redberg RF, Grady D, Fleischmann KE: The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography: a meta-analysis. J Am Coll Cardiol. 2007, 49: 227-327. 10.1016/j.jacc.2006.08.048.CrossRefPubMed
25.
go back to reference Shavelle DM, Budoff MJ, LaMont DH, Shavelle RM, Kennedy JM, Brundage BH: Exercise testing and electron beam computed tomography in the evaluation of coronary artery disease. J Am Coll Cardiol. 2000, 36: 32-38. 10.1016/S0735-1097(00)00696-3.CrossRefPubMed Shavelle DM, Budoff MJ, LaMont DH, Shavelle RM, Kennedy JM, Brundage BH: Exercise testing and electron beam computed tomography in the evaluation of coronary artery disease. J Am Coll Cardiol. 2000, 36: 32-38. 10.1016/S0735-1097(00)00696-3.CrossRefPubMed
26.
go back to reference Berman DS, Wong ND, Gransar H, Miranda-Peats R, Dahlbeck J, Hayes SW, Friedman JD, Kang X, Polk D, Hachamovitch R, Shaw L, Rozanski A: Relationship between stress-induced myocardial ischemia and atherosclerosis measured by coronary calcium tomography. J Am Coll Cardiol. 2004, 44: 923-930. 10.1016/j.jacc.2004.06.042.CrossRefPubMed Berman DS, Wong ND, Gransar H, Miranda-Peats R, Dahlbeck J, Hayes SW, Friedman JD, Kang X, Polk D, Hachamovitch R, Shaw L, Rozanski A: Relationship between stress-induced myocardial ischemia and atherosclerosis measured by coronary calcium tomography. J Am Coll Cardiol. 2004, 44: 923-930. 10.1016/j.jacc.2004.06.042.CrossRefPubMed
Metadata
Title
The role of coronary artery calcification score in clinical practice
Authors
Lieuwe H Piers
Farah Salachova
Riemer HJA Slart
Rozemarijn Vliegenthart
Riksta Dikkers
Frederique AP Hospers
Hjalmar R Bouma
Clark J Zeebregts
Tineke P Willems
Matthijs Oudkerk
Felix Zijlstra
René A Tio
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2008
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/1471-2261-8-38

Other articles of this Issue 1/2008

BMC Cardiovascular Disorders 1/2008 Go to the issue