Coronary artery calcium score above 250 confirms the presence of significant stenosis in coronary CT angiography of symptomatic patients

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ghazi A. Alshumrani
Keyword(s):  
Coronary Artery ◽  
Ct Angiography ◽  
Coronary Artery Calcium ◽  
Coronary Ct Angiography ◽  
Coronary Artery Calcium Score ◽  
Calcium Score ◽  
Significant Stenosis ◽  
Coronary Ct

scholarly journals Downstream testing after an halted coronary CT angiography due to high coronary artery calcium score

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Gama ◽  
B Rocha ◽  
P Freitas ◽  
A Ferreira ◽  
J Abecasis ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Ct Angiography ◽  
Coronary Artery Calcium ◽  
Coronary Ct Angiography ◽  
Coronary Artery Calcium Score ◽  
Invasive Coronary Angiography ◽  
Calcium Score ◽  
Coronary Ct ◽  
Test Probability

Abstract Background and aim In many centers, coronary artery calcium score (CACS) is performed immediately before coronary CT angiography (CCTA) in order to exclude heavy calcification that could hamper test performance. When high CACS values are found, CCTA is usually aborted and other tests suggested. However, there are no recommendations on which test to pursue, and little data on their diagnostic yield in this setting. The aim of this study was to assess the type and results of downstream testing among patients whose CCTA study was halted due to high CACS. Methods Single-centre retrospective study of consecutive patients undergoing CCTA for suspected obstructive coronary artery disease (CAD). A CACS threshold of >400 was generally used to cancel CCTA. Downstream testing and its results were assessed using electronic medical records. A group of consecutive patients with CACS <400 who underwent CCTA was used for comparison. Results Of the 795 patients who performed CCTA for suspected CAD, 86 (10.8%), had their test halted due to high CACS (57 men, mean age 71±11 years). In this subgroup, the median pre-test probability for CAD was 27% (interquartile range 25) and the median CACS was 983 (interquartile range 930). Compared to patients who underwent CCTA, those who saw their tests cancelled were older, more frequently male, and had higher prevalence of cardiovascular risk factors and higher pre-test probability for CAD. Patient's downstream testing is illustrated in Figure. From the 86 patients enrolled, 12 are currently waiting for downstream tests and were excluded from further analysis. Overall, 35 patients ended up performing invasive coronary angiography (ICA, 47.3%) of whom 19 (54.3%) had significant CAD. Among those who underwent non-invasive testing (N=19, 25.7%), 10 (52.6%) had significant ischemia and 4 (21%) underwent additional testing with ICA. In 24 patients (32.4%), no downstream testing was pursued. Finally, 17 (22.3%) patients underwent coronary revascularization, either percutaneous (N=10, 13.5%) or surgical (N=7, 10.8%). Conclusion Invasive coronary angiography is the most frequently used downstream test when CCTA is halted due to high CACS values, and shows significant CAD in roughly half of the cases. Considering the high prevalence of significant CAD, direct referral for ICA (with the possibility of invasive functional testing) seems a reasonable approach. Funding Acknowledgement Type of funding source: None

scholarly journals Calcium scoring: a personalized probability assessment predicts the need for additional or alternative testing to coronary CT angiography

2020 ◽  
Vol 30 (10) ◽  
pp. 5499-5506
Author(s):  
Judit Simon ◽  
Lili Száraz ◽  
Bálint Szilveszter ◽  
Alexisz Panajotu ◽  
Ádám Jermendy ◽  
...  
Keyword(s):  
Heart Rate ◽  
Coronary Artery ◽  
Ct Angiography ◽  
Coronary Ct Angiography ◽  
Calcium Score ◽  
Final Decision ◽  
Operating Characteristics ◽  
Coronary Cta ◽  
Coronary Ct ◽  
Cutoff Values

Abstract Objective To assess whether anthropometrics, clinical risk factors, and coronary artery calcium score (CACS) can predict the need of further testing after coronary CT angiography (CTA) due to non-diagnostic image quality and/or the presence of significant stenosis. Methods Consecutive patients who underwent coronary CTA due to suspected coronary artery disease (CAD) were included in our retrospective analysis. We used multivariate logistic regression and receiver operating characteristics analysis containing anthropometric factors: body mass index, heart rate, and rhythm irregularity (model 1); and parameters used for pre-test likelihood estimation: age, sex, and type of angina (model 2); and also added total calcium score (model 3) to predict downstream testing. Results We analyzed 4120 (45.7% female, 57.9 ± 12.1 years) patients. Model 3 significantly outperformed models 1 and 2 (area under the curve, 0.84 [95% CI 0.83–0.86] vs. 0.56 [95% CI 0.54–0.58] and 0.72 [95% CI 0.70–0.74], p < 0.001). For patients with sinus rhythm of 50 bpm, in case of non-specific angina, CACS above 435, 756, and 944; in atypical angina CACS above 381, 702, and 890; and in typical angina CACS above 316, 636, and 824 correspond to 50%, 80%, and 90% probability of further testing, respectively. However, higher heart rates and arrhythmias significantly decrease these cutoffs (p < 0.001). Conclusion CACS significantly increases the ability to identify patients in whom deferral from coronary CTA may be advised as CTA does not lead to a final decision regarding CAD management. Our results provide individualized cutoff values for given probabilities of the need of additional testing, which may facilitate personalized decision-making to perform or defer coronary CTA. Key Points • Anthropometric parameters on their own are insufficient predictors of downstream testing. Adding parameters of the Diamond and Forrester pre-test likelihood test significantly increases the power of prediction. • Total CACS is the most important independent predictor to identify patients in whom coronary CTA may not be recommended as CTA does not lead to a final decision regarding CAD management. • We determined specific CACS cutoff values based on the probability of downstream testing by angina-, arrhythmia-, and heart rate–based groups of patients to help individualize patient management.

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