Erica Maffei MD, Presenter: Nothing to Disclose

Chiara Martini MChir, Abstract Co-Author: Nothing to Disclose

Chiara Lario, Abstract Co-Author: Nothing to Disclose

Teresa Arcadi MD, Abstract Co-Author: Nothing to Disclose

Sara Seitun MD, Abstract Co-Author: Nothing to Disclose

Filippo Cademartiri MD, PhD, Abstract Co-Author: Speakers Bureau, Bracco Group Research grant, General Electric Company

To evaluate diagnostic accuracy of Computed Tomography Coronary Angiography (CTCA) and Coronary Artery Calcium Score (CACS) for the detection of significant coronary artery stenosis (≥50% lumen reduction) as compared to conventional coronary angiography (CAG) in patients with Acute Chest Pain (ACP) of suspected cardiac origin.

237 consecutive patients (187 males, mean age 63±10 yrs) with ACP underwent CACS, CTCA (Sensation 64 Cardiac, Siemens) and CAG. Diagnostic accuracy and likelihood ratios (LR) of CTCA and CACS were assessed against CAG in total population and sub-groups of CACS (CACS 0, 1-100, 101-400, 401-1000, >1000). The thresholds for significant CACS were adopted at Agatston score 1, 11, 101, 401, 1001. Stenosis with ≥50% lumen reduction were considered significant for CTCA and CAG.

Prevalence of obstructive disease was 53%. In per-patient analysis sensitivity, specificity, positive and negative predictive value of CTCA were 100% (regardless of CACS value) 95% (94-96% in CACS sub-groups except for CACS 1-100 = 60%), 95% (83-100 in CACS sub-groups), 100% (regardless of CACS value), respectively. In per-patient analysis sensitivity, specificity, positive and negative predictive value of CACS ranged in CACS>0 to CACS >1000 from 92% to 17%, from 49% to 100%, from 67% to 100%, from 84% to 51%, respectively. For CTCA LR+ ranged between 3 and 26, and LR- were always 0, while for CACS LR+ ranged between 1.6 and 1.8, and while LR- ranged between 0.16 and 0.83. Diagnostic accuracy of CTCA was far superior to CACS in any condition (p<0.05).  

CTCA is a reliable diagnostic modality with high sensitivity and negative predictive value in ACP. Instead, CACS cannot be used for diagnostic purposes in these settings.

In the setting of acute chest pain, CTCA is a valuable diagnostic modality with high sensitivity and negative predictive value. CACS cannot be used for diagnostic purposes in these high risk patients.

Maffei, E, Martini, C, Lario, C, Arcadi, T, Seitun, S, Cademartiri, F, Acute Chest Pain of Suspected Cardiac Origin: Diagnostic Accuracy of Calcium Score and Computed Tomography Coronary Angiography.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11010193.html