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Rofo. 2013 Aug;185(8):726-32. doi: 10.1055/s-0033-1335964. Epub 2013 Jul 30.

Predictive value of zero calcium score and low-end percentiles for the presence of significant coronary artery stenosis in stable patients with suspected coronary artery disease.

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1
Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Heidelberg University, Mannheim, Germany.

Abstract

PURPOSE:

To prospectively investigate the predictive value of a zero calcium score (CS) value as well as age- and sex-adjusted low-end CS percentiles for the presence of significant coronary artery stenosis in stable patients with suspected coronary artery disease (CAD).

MATERIALS AND METHODS:

In total, 87 consecutive stable patients with suspected CAD were prospectively enrolled in this study (33 women; 66 ± 10 years). All patients underwent non-enhanced CT for calcium scoring (CSCT) and contrast-enhanced coronary CT angiography (cCTA). Invasive coronary angiography (ICA) served as the reference standard in all patients. Diagnostic performance for the presence of significant stenosis (≥ 50% diameter) was calculated separately for CS in comparison to cCTA and ICA.

RESULTS:

ICA identified significant stenosis in 56/87 patients (64%). The mean CS was 571 ± 599. On a per patient based analysis, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for patients with a zero CS were 98.5%, 18.2%, 78.0% and 80.0%, respectively, compared to cCTA and 100%, 16.1%, 68.3% and 100%, respectively, compared to ICA. Low-end age- and sex-adjusted percentiles derived from asymptomatic Caucasian populations showed results comparable to a CS of zero.

CONCLUSION:

The prevalence of significant coronary artery stenosis is low in stable patients with suspected CAD and a CS of zero but also in patients below certain low-end age- and sex-adjusted percentile ranks. Thus, CS should be used as a gatekeeper prior to further diagnostic procedures in these patients. A CS value below certain age- and sex-adjusted percentile ranks seems to be of identical diagnostic value to a CS of zero in stable patients.

PMID:
23900940
DOI:
10.1055/s-0033-1335964
[Indexed for MEDLINE]
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