Using Coronary Artery Calcium Score as Diagnostic Tool in Symptomatic Chronic Coronary Syndrome Patients in a Real-Life Setting

Abstract

Background

The coronary artery calcium (CAC) score can be used to increase (CAC score > 0) or decrease (CAC score = 0) the likelihood of coronary artery disease (CAD). We compared the CAC score with the pre-test probability (PTP) for CAD (low, intermediate, and high). Furthermore, we compared the CAC score with exercise electrocardiography (ECG) and compared both tests with coronary angiography.

Methods and Results

We retrospectively identified patients with angina and/or dyspnea for whom CAC score was used to increase or decrease the likelihood of CAD. Of 882 patients, majority had low (45%) or intermediate (44%) PTP. Patients with higher PTP had significantly higher CAC scores (Cramer’s V = 0.29, p < 0.0001). Most patients (57%) had a CAC score of zero, especially those with low (73%) and intermediate (49%) PTP. However, 20% of patients with high PTP had CAC score of zero. Higher CAC scores were observed in patients with abnormal exercise ECG, but association was weak and not significant (Cramer’s V = 0.13, p = 0.08). Moreover, more than 40% of patients with an abnormal exercise ECG had CAC score of zero. Higher CAC scores were associated with more severe abnormalities on coronary angiography (Cramer’s V = 0.43, p < 0.0001), whereas there was no association between results of exercise ECG and coronary angiography (Cramer’s V = 0.11, p = 0.91).

Conclusion

CAC score can be used in addition to PTP to increase or decrease the likelihood of CAD, and it might be more useful than exercise ECG in the diagnostic work-up of chest pain.

Keywords:

• coronary artery disease
• cardiovascular disease
• CT
• risk factors
• angina
• stable

Data Sharing Statement

The data underlying this article will be shared upon reasonable request by the corresponding author.

Disclosure

The authors report no relationships that could be construed as a conflict of interest.

Additional information

Funding

The manuscript was funded by an unrestricted grant provided by the Tergooi Academy, Tergooi Medical Center, the Netherlands, for the PhD project of the main author, M. Patrick Witvliet.