RT Journal Article
T1 Should computed tomography coronary angiography be aborted when the calcium score exceeds a certain threshold in patients with chest pain?
A1 De Agustín Loeches, José Alberto
A1 Marcos-Alberca, Pedro
A1 Fernández-Golfin, Covadonga
A1 Feltes, Gisela
A1 Nuñez-Gil, Ivan Javier
A1 Almeria, Carlos
A1 Rodrigo López, José Luis
A1 Arrazola García, Juan Lorenzo
A1 Pérez De Isla, Leopoldo
A1 Macaya Miguel, Carlos
A1 Zamorano Gómez, José Luis
AB Background: There is ongoing debate about whether a computed tomography coronary angiography (CTCA)should be aborted when the calcium score (CS) exceeds a certain threshold in patients with chest pain. Theaim of this study was to discover whether specific “cutpoints” regarding coronary artery CS could be determined to predict severe coronary stenoses assessed by CTCA, thus identifying patients amenable to an invasive diagnostic approach.Methods: 294 consecutive patients with chest pain of uncertain cause who were referred for non-invasive diagnostic CTCA were included. Subjects underwent Agatston CS and CTCA using current 64-slice technology.Results: Severe coronary stenoses were noted in 75 of 294 (25.1%) patients on CTCA. A very high prevalence ofsevere coronary stenoses was found in patients with CS ≥400 (87.0%). The CS had area under the ROC curve0.86 to predict severe coronary stenoses on CTCA. The best discriminant cut-off point was CS ≥400 (sensitivityof 55.3%, specificity of 93.5, positive predictive value of 85.8%, negative predictive value of 84.0%). Multivariablelogistic regression analysis controlling for traditional risk factors showed CS ≥400 remained an independentpredictor of severe coronary stenoses on CTCA (OR 14.553, 95% confidence interval 4.043 to 52.384, pb0.001).Conclusions: CS can be used as a “gatekeeper” to CTCA in patients with chest pain. Due to the very high prevalence of severe coronary stenoses in patients with CS ≥400, further evaluation with CTCA is not warranted asthese patients should be referred to invasive coronary angiography, avoiding the repeated exposure to ionizingradiation and iodinated contrast.
PB Elsevier
SN 0167-5273
YR 2013
FD 2013
LK https://hdl.handle.net/20.500.14352/131341
UL https://hdl.handle.net/20.500.14352/131341
LA eng
NO de Agustin, J. A., Marcos-Alberca, P., Fernández-Golfin, C., Feltes, G., Nuñez-Gil, I. J., Almeria, C., Rodrigo, J. L., Arrazola, J., Pérez de Isla, L., Macaya, C., & Zamorano, J. (2013). Should computed tomography coronary angiography be aborted when the calcium score exceeds a certain threshold in patients with chest pain?. International journal of cardiology, 167(5), 2013–2017. https://doi.org/10.1016/j.ijcard.2012.05.041
DS Docta Complutense
RD 27 feb 2026