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 |
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Authors: | Christiane A Geluk Riksta Dikkers Patrick J Perik René A Tio Marco J W Götte Hans L Hillege Rozemarijn Vliegenthart Janneke B Houwers Tineke P Willems Matthijs Oudkerk Felix Zijlstra |
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Institution: | (1) Thoraxcenter, Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, PB 30001, 9700 RB Groningen, The Netherlands;(2) Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands |
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Abstract: | We determined the efficiency of a screening protocol based on coronary calcium scores (CCS) compared with exercise testing
in patients with suspected coronary artery disease (CAD), a normal ECG and troponin levels. Three-hundred-and-four patients
were enrolled in a screening protocol including CCS by electron beam computed tomography (Agatston score), and exercise testing.
Decision-making was based on CCS. When CCS≥400, coronary angiography (CAG) was recommended. When CCS<10, patients were discharged.
Exercise tests were graded as positive, negative or nondiagnostic. The combined endpoint was defined as coronary event or
obstructive CAD at CAG. During 12±4 months, CCS≥400, 10–399 and <10 were found in 42, 103 and 159 patients and the combined
endpoint occurred in 24 (57%), 14 (14%) and 0 patients (0%), respectively. In 22 patients (7%), myocardial perfusion scintigraphy
was performed instead of exercise testing due to the inability to perform an exercise test. A positive, nondiagnostic and
negative exercise test result was found in 37, 76 and 191 patients, and the combined endpoint occurred in 11 (30%), 15 (20%)
and 12 patients (6%), respectively. Receiver-operator characteristics analysis showed that the area under the curve of 0.89
(95% CI: 0.85–0.93) for CCS was superior to 0.69 (95% CI: 0.61–0.78) for exercise testing (P<0.0001). In conclusion, measurement of CCS is an appropriate initial screening test in a well-defined low-risk population
with suspected CAD. |
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Keywords: | Coronary calcium Exercise test MDCT EBCT Coronary artery disease |
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