Coronary calcium score as gatekeeper for 64-slice computed tomography coronary angiography in patients with chest pain: per-segment and per-patient analysis |
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Authors: | Anselmo Alessandro Palumbo Erica Maffei Chiara Martini Giuseppe Tarantini Gian Luca Di Tanna Elena Berti Roberto Grilli Giancarlo Casolo Valerio Brambilla Marcella Cerrato Antonio Rotondo Annick C Weustink Nico R A Mollet Filippo Cademartiri |
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Institution: | 1. Department of Radiology and Cardiology, Azienda Ospedaliero-Universitaria di Parma, Non-Invasive Cardiovascular Imaging, Piastra Tecnica - Piano 0, Via Gramsci, 14, 43100, Parma, Italy 2. Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands 3. Department of Cardiology, University of Padua, Padua, Italy 4. Regional Health Agency, Regione Emilia Romagna, Bologna, Italy 5. Department of Cardiology, Ospedale Versilia, Viareggio, Italy 6. Cardiovascular Rehabilitation Unit, Don Gnocchi ONLUS, Parma, Italy 7. Department of Radiology, University of Naples, Naples, Italy
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Abstract: | We sought to investigate the performance of 64-slice CT in symptomatic patients with different coronary calcium scores. Two
hundred patients undergoing 64-slice CT coronary angiography for suspected coronary artery disease were enrolled into five
groups based on Agatston calcium score using the Mayo Clinic risk stratification: group 1: score 0, group 2: score 1–10, group
3: score 11–100, group 4: score 101–400, and group 5: score > 401. Diagnostic accuracy for the detection of significant (≥50%
lumen reduction) coronary artery stenosis was assessed on a per-segment and per-patient base using quantitative coronary angiography
as the gold standard. For groups 1 through 5, sensitivity was 97, 96, 91, 90, 92%, and specificity was 99, 98, 96, 88, 90%,
respectively, on a per-segment basis. On a per-patient basis, the best diagnostic performance was obtained in group 1 (sensitivity
100% and specificity 100%) and group 5 (sensitivity 95% and specificity 100%). Progressively higher coronary calcium levels
affect diagnostic accuracy of CT coronary angiography, decreasing sensitivity and specificity on a per-segment base. On a
per-patient base, the best results in terms of diagnostic accuracy were obtained in the populations with very low and very
high cardiovascular risk.
Authors have no financial conflict of interest. Neither this paper nor any of its content has not been submitted to other
journals. |
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Keywords: | Coronary angiography Calcium score Cardiovascular risk Mayo Clinic classification Multislice computed tomography |
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