Rofo 2013; 185(8): 726-732
DOI: 10.1055/s-0033-1335964
Herz
© Georg Thieme Verlag KG Stuttgart · New York

Predictive Value of Zero Calcium Score and Low-End Percentiles for the Presence of Significant Coronary Artery Stenosis in Stable Patients with Suspected Coronary Artery Disease

Prädiktiver Wert eines negativen Kalzium-Scores und niedriger Perzentilen für die Präsenz signifikanter koronararterieller Stenosen bei stabilen Patienten mit Verdacht auf koronare Herzkrankheit
N. Vogler
1   Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Heidelberg University, Mannheim
,
M. Meyer
1   Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Heidelberg University, Mannheim
,
C. Fink
2   Department of Radiology, General Hospital Celle
,
U. J. Schoepf
3   Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston
,
S. O. Schönberg
1   Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Heidelberg University, Mannheim
,
T. Henzler
1   Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Heidelberg University, Mannheim
› Author Affiliations
Further Information

Publication History

20 January 2013

29 May 2013

Publication Date:
30 July 2013 (online)

Abstract

Purpose: To prospectively investigate the predictive value of a zero calcium score (CS) value as well as age- and sex-adjusted low-end CS percentiles for the presence of significant coronary artery stenosis in stable patients with suspected coronary artery disease (CAD).

Materials and Methods: In total, 87 consecutive stable patients with suspected CAD were prospectively enrolled in this study (33 women; 66 ± 10 years). All patients underwent non-enhanced CT for calcium scoring (CSCT) and contrast-enhanced coronary CT angiography (cCTA). Invasive coronary angiography (ICA) served as the reference standard in all patients. Diagnostic performance for the presence of significant stenosis (≥ 50 % diameter) was calculated separately for CS in comparison to cCTA and ICA.

Results: ICA identified significant stenosis in 56/87 patients (64 %). The mean CS was 571 ± 599. On a per patient based analysis, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for patients with a zero CS were 98.5 %, 18.2 %, 78.0 % and 80.0 %, respectively, compared to cCTA and 100 %, 16.1 %, 68.3 % and 100 %, respectively, compared to ICA. Low-end age- and sex-adjusted percentiles derived from asymptomatic Caucasian populations showed results comparable to a CS of zero.

Conclusion: The prevalence of significant coronary artery stenosis is low in stable patients with suspected CAD and a CS of zero but also in patients below certain low-end age- and sex-adjusted percentile ranks. Thus, CS should be used as a gatekeeper prior to further diagnostic procedures in these patients. A CS value below certain age- and sex-adjusted percentile ranks seems to be of identical diagnostic value to a CS of zero in stable patients.

Zusammenfassung

Ziel: Prospektive Ermittlung des prädiktiven Wertes eines negativen Kalzium-Scores (CS) sowie niedriger geschlechts- und altersspezifischer Perzentilen hinsichtlich der Präsenz signifikanter koronararterieller Stenosen bei stabilen Patienten mit Verdacht auf koronare Herzkrankheit (CAD).

Material und Methoden: Insgesamt wurden 87 stabile Patienten mit Verdacht auf CAD (33 Frauen, 66 ± 10 Jahre) in diese prospektive Studie eingeschlossen. Alle Patienten erhielten eine native CT zur Messung des Kalk-Scores (CSCT), eine Koronar-CT-Angiografie (cCTA) sowie als Referenzstandard eine invasive Koronarangiografie (ICA). Die diagnostische Genauigkeit des CS hinsichtlich der Präsenz signifikanter Stenosen (≥ 50 % Durchmesser) wurde separat im Vergleich zur cCTA und ICA ermittelt.

Ergebnisse: Die ICA zeigte bei 56/87 Patienten (64 %) eine signifikante Stenose. Der mittlere CS betrug 571 ± 599. Auf Patientenbasis ergaben sich für Patienten mit einem negativen CS Sensitivität, Spezifität, positiver prädiktiver Wert (PPV) und negativer prädiktiver Wert (NPV) von 98,5 %, 18,2 %, 78,0 % und 80,0 % im Vergleich zur cCTA und 100 %, 16,1 %, 68,3 % und 100 % im Vergleich zur ICA. Niedrige, von asymptomatischen Kaukasiern abgeleitete, geschlechts- und altersspezifischen Perzentilen zeigten vergleichbare Ergebnisse.

Schlussfolgerung: Bei stabilen Patienten mit Verdacht auf CAD sind signifikante Stenosen sowohl bei einem negativen CS als auch bei einem Wert unterhalb bestimmter geschlechts- und altersspezifischer Perzentilen selten. Daher sollte der CS bei diesen Patienten als Filter vor Durchführung weiterer diagnostischer Maßnahmen dienen. Ein CS-Wert unterhalb bestimmter geschlechts- und altersspezifischer Perzentilen scheint bei stabilen Patienten eine dem negativen CS gleichwertige Aussagekraft zu besitzen.

 
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