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Coronary Artery Calcium (CAC) scoring may have potential as a gatekeeper to further testing with Coronary Computed Tomography Angiography (CCTA) or other tests in patients presenting with chest pain and suspected Coronary Artery Disease (CAD). Apart from a substudy of the CONFIRM Registry, other studies evaluating CAC for this role had limited sample sizes with conflicting results. Moreover, none of these studies were performed in an Asian population. The aim of our study was to assess the Negative Predictive Value (NPV) of CAC scoring for CAD as defined by CCTA in a large symptomatic Asian population.
This was a single-center, observational study of all patients referred to our institution for CCTA from March 2007 to September 2012. All patients underwent CAC prior to CCTA as part of a standard protocol. Patients with prior infarct, previous revascularization or uninterpretable scans were excluded from the study.
Of 3073 patients who underwent CAC scoring and CCTA, 1191 patients [Male=684, Female=507, Mean age= 50 years (SD=10.3), Mean BMI= 25 (SD=4.0), 68% Chinese, 12% Southeast Asian, 9% Indian, 4% Unknown, 3% Malay, 3% South Asian, <1% Others] had a CAC score of 0. Seven of 1191 patients (0.6%) had severe stenosis (≥70% stenosis) while 23 of 1191 patients (1.9%) had moderate to severe stenosis (≥50% stenosis). The negative predictive value for ≥70% stenosis was 99.4% and that for ≥50% stenosis was 98.0%.
In a largely symptomatic Asian population referred to our institution for CCTA, a calcium score of 0 has a very high NPV of 99.4% for excluding severe coronary artery stenosis (≥70% stenosis). It can potentially serve as a gatekeeper for CCTA or other functional testing in patients who present with chest pain at our institution.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Imaging: CT/Multimodality V
Abstract Category: 20. Imaging: CT/Multimodality
Presentation Number: 1228M-352
- 2013 American College of Cardiology Foundation