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 |
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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 |
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Affiliation: | 1. Department of Radiology and Cardiology, Azienda Ospedaliero-Universitaria, Parma, Italy 2. Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands 5. Department of Radiology, c/o Piastra Tecnica - Piano 0, Azienda Ospedaliero-Universitaria, Parma, Via Gramsci, 14, 43100, Parma, Italy 3. Department of Radiology and Cardiology, Ospedale San Gennaro, Naples, Italy 4. Department of Radiology, University of Palermo, Palermo, Italy
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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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