Diagnostic Efficacy of Vessel Specific Coronary Calcium Score in Detection of Coronary Artery Stenosis

Abstract

Background:Coronary artery calcification which is determined quantitatively by coronary calcium scoring has been known as a sign of coronary stenosis and thus future cardiac events; hence it has been noticed on spotlight of researchers in recent years. Developing different method for early and optimal detection of coronary artery disease (CAD) is really essential as CAD are the first cause of death in population.Objectives:To evaluate predictive value of vessel specific coronary artery calcium (CAC) score in predicting obstructive coronary artery disease.Patients and Methods:In this diagnostic test study we evaluated patients with coronary computed tomography angiography (CCTA) and CAC score which had been referred to two referral radiology center in Tehran, Iran and finally we selected 2525 patients in a single and sequential pattern to create a diagnostic study. The whole-heart CAC scores and vessel specific CAC scores were calculated individually for the 4 major epicardial coronary arteries in 2 distinct group; group A ( patients with previous history of CABG) and group B (patients without history of CABG). For evaluation of obstruction tree cut off points were described: 0 > ; at least 1 segment with any kind of stenosis, ≥ 50; at least 1 segment with stenosis ≥ 50, ≥ 70; at least 1 segment with stenosis ≥ 70.Results:Mean of coronary calcium scores in terms of each coronary artery vessel increase by increasing coronary stenosis grade in group B; LAD, RCA, LCX respectively have mean CAC score 6.06, 6.21 and 5.04 in normal patients and 221.6, 226.7 and 106.6 in patients with complete stenosis. As expected these findings don't work for group A. Also By increasing calcium score cutoff in all four vessels sensitivity decreased and specificity increased but steal LAD had higher sensitivity than other vessels and LM had higher specificity. Thus using calcium score method is useful for ruling out stenosis in LAD while calcium score of LM can predict existence of stenosis in LM. However none of the vessel specific CAC can reach to 100% sensitivity and specificity of CCTA method.Conclusions:CCTA is highly superior than vessel specific CAC score thus to minimize patients radiation does maybe we can eliminate CAC scan as a routinely perform procedure at the beginning of the CCTA.

Prognostic Value of Coronary Artery Calcium Score for Determination of Presence and Severity of Coronary Artery Disease

“…Overall, there were great controversies in this regard. The results of two different studies from our region were not similar either [13,14]. Thus, we aimed to evaluate the usefulness of this score for predicting CAD, its severity and CAD-related risk factors in our population.…”

“…As mentioned above, the results of different studies regarding the usefulness of CACS for predicting coronary artery stenosis are not conclusive [10–14]. Some authors suggested that it could be a good predicting factor for mild to moderate stenosis [13].…”

“…Some authors suggested that it could be a good predicting factor for mild to moderate stenosis [13]. Others have reported that it has insufficient predictive value [14]. Overall, there were great controversies in this regard.…”

“…The results of two recent regional studies were not similar either [13,14]. Almasi et al evaluated the value of CACS for predicting the presence and severity of CAD among 202 patients.…”

“…There are also some studies evaluating the prognostic value of CACS for determining the presence and severity of CAD [13,14]. There are controversies regarding the usefulness of CACS for predicting coronary artery stenosis.…”