Tamar Gaspar MD, Presenter: Nothing to Disclose

Ronen Rubinshtein MD, Abstract Co-Author: Nothing to Disclose

David Anthony Halon MBChB, Abstract Co-Author: Nothing to Disclose

Liran Domachevsky MD, Abstract Co-Author: Nothing to Disclose

Basil Lewis MD, Abstract Co-Author: Nothing to Disclose

Nathan Peled MD, Abstract Co-Author: Nothing to Disclose

The coronary calcium score (CS) is well established as a predictor for future myocardial events. Coronary CT angiography (CCTA) correlates well with angiographic findings on selective coronary angiography but its predictive value for late events is unknown.

CCTA (Philips, Br-64 or Br-40) was assessed in 546 consecutive pts without known coronary disease (58+12 yrs, 31% women) referred for investigation of a chest pain syndrome. Predictive value of CTA defined stenosis (>25%) and of Agatston calcium score (>100) for MACE (death, myocardial infarction, revascularization, hospitalization for acute coronary syndrome) was assessed at 18.6+ 6.3 (range 9-30) months.

MACE rate increased with higher calcium score [CS>100 62/171 (36%) vs CS100. MACE rate also increased with percent stenosis on CTA [CTA 50%, 56/108 (52%) p25%. CS <100 and CTA <25% combined, excluded MACE in 280/282 pts (98% sensitivity, 62% specificity and 99% NPV).

In pts with chest pain syndromes without a known coronary disease: 1. Late MACE rate increased with higher calcium score and increasing CTA stenosis. 2. Low calcium score alone did not exclude MACE. 3. CTA stenosis >25% markedly improved sensitivity and negative predictive value of calcium score for MACE.

CS identifies patients at risk for future events CCTA correlates well with invasive angiography but its predictive value for late events is unknown.

Gaspar, T, Rubinshtein, R, Halon, D, Domachevsky, L, Lewis, B, Peled, N, Coronary CT Angiography Improves Sensitivity and Negative Predictive Value of Coronary Calcium Score for Late Cardiac Events in Patients with Chest Pain Syndromes.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5014975.html