Author + information
Fluoroscopically detected coronary artery calcification is aproven modality for prediction of coronary artery disease (CAD) in asymptomatic patients. In one research the predictive accuracy of CAC in asymptomatic male patients was very high (100% for CAD and 92% for clinically significant CAD) Fluroscopically calcification finding confirmed the presence of already existing significant stenosis on the coronary artery or a high risk for hemodynamic disorder in another study. The SYNTAX score is a unique tool to score complexity of coronary artery disease. We wanted to investigate the relationship between fluoroscopically detected coronary artery calcification (CAC) and burden of CAD in consecutive patients using syntax score.
Fluoroscopically detected CAC was investigated in 338 patients in outpatient clinic. All patients were underwent coronary angiography. The relationship between fluoroscopically detected calcification and burden of coronary artery disease using syntax score and number of disease vessel were researched. Coronary calcification density, lengthiness, localization and accompanied with thrombus and other features were recorded. All statistical analysis were done by using SPSS 18.
Most of the patients were asymptomatic (89%) but the others had chest pain symptoms. (11%) There were 230 male patients (68%, mean age 62±2 years old), 108 female patients. (32%, mean age 65±3 years old) Hypertension was in 78%, type 2 diabetes mellitus in 17%, hyperlipidemia in 35% and smoking in 33%. Fluoroscopically detected CAC were found in 94 patients (27,8%) and not found in 244 patients (72,2%). 212 patients (62,7%) had CAD and 126 patients (37,3%) didn't have. 95 patients (28,1%) one vessel, 117 patients (34,6%) had two or more CAD. We can see crosstabs table of frequency distribution of CAC & CAD in table 1. Correlation analysis showed weak correlation between CAC & CAD but reached statistical significance.(Table1)
Pearson chi-Square value: 20,515, p<0,0001 and Continuity Correction value: 19,393, p<0,0001. Pearson Correlation value: 0,246, p<0,0001
The sensitivity of CAC for detection CAD was 77,3% and specifity was 86,5%. Positive predictivity was 81,9% and negative predictivity 44,6%. (Table2) Also there was a good relationship between CAC and possibility of 2 or more vessel CAD. (Table3) (p<0,0001) Findings of positive fluoroscopically CAC meant more intermediate and high Syntax score than negative CAC. (Table 4) Fluorocopically detected CAC was found to have a correlation with many findings of CAD so maybe in the future that will be more common in screening asymptomatic patients in outpatient clinics.
Our study showed that fluoroscopically detected CAC was easy and confidential method to screen many patients. The value of the method will be rised with more trials.
|CAD positive||CAD negative||Total|
|Calcification positive||77 (81,9%)||17 (18,1%)||94 (27,8%)|
|Calcification negative||135 (55,3%)||109 (44,7%)||244 (72,2%)|
|Total||212 (62,7 %)||126 (37,3%)||338 (100%)|
|Pearson chi-Square value: 20,515, p <0,0001||Continuity Correction value: 19,393, p<0,0001||Pearson Correlation value:0,246, p<0,0001|
|Sensitivity||Specifity||Positive Pre.||Negative Pre.|
|Value of CAC for detection CAD||77,3%||86,5%||81,9%||44,6%|
|None||1 vessel CAD||2 or more vessel CAD|
|CAC positive||17 (18,1%)||126 (37,3%)||50 (53,2%)|
|CAC negative||109 (44,7%)||68 (27,9%)||67 (27,5%)|
|Total||126 (37,3%)||95(28,1%)||117 (34,6%)|
|Pearson Chi-Square value: 33,462, p<0,0001,||Pearson Correlation value: 0,304, p<0,0001|
|Low Syntax Score (0-22)||Intermediate S.C|
|High Syntax Score|
|CAC positive||67 (69,3%)||24 (25,5%)||3 (3,2%)|
|CAC negative||220 (91,9%)||21 (8,5%)||3 (1,2%)|
|Total||287 (85,4%)||45 (13,5%)||6 (1,8%)|