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Controlled Clinical Trial
. 2008 Feb;18(2):244-52.
doi: 10.1007/s00330-007-0755-2. Epub 2007 Sep 28.

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

Christiane A Geluk  1 , 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
Affiliations
Controlled Clinical Trial

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

Christiane A Geluk et al. Eur Radiol. 2008 Feb.

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>or=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>or=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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Figures

Fig. 1
Fig. 1
Flow chart
Fig. 2
Fig. 2
Outcome according to CCS and exercise testing. The percentage of patients with the combined endpoint are shown per group
Fig. 3
Fig. 3
ROC curves of CCS (<10, 10–399 and ≥400) and exercise testing (negative, nondiagnostic, positive) for the combined endpoint. The difference in AUCs of both tests show the incremental diagnostic yield of measurement of CCS when compared with exercise testing (P<0.0001)
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