Using Coronary Artery Calcium Score as Diagnostic Tool in Symptomatic Chronic Coronary Syndrome Patients in a Real-Life Setting

M Patrick Witvliet; E Karin Arkenbout; Pieter W Kamphuisen

doi:10.2147/VHRM.S422458

Using Coronary Artery Calcium Score as Diagnostic Tool in Symptomatic Chronic Coronary Syndrome Patients in a Real-Life Setting

Vasc Health Risk Manag. 2023 Sep 5:19:571-582. doi: 10.2147/VHRM.S422458. eCollection 2023.

Authors

M Patrick Witvliet^{1

2}, E Karin Arkenbout³, Pieter W Kamphuisen^{1

4}

Affiliations

¹ Department of Internal Medicine, Tergooi Medical Center, Hilversum, the Netherlands.
² Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands.
³ Department of Cardiology, Tergooi Medical Center, Hilversum, the Netherlands.
⁴ Department of Vascular Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.

Abstract

Background: The coronary artery calcium (CAC) score can be used to increase (CAC score > 0) or decrease (CAC score = 0) the likelihood of coronary artery disease (CAD). We compared the CAC score with the pre-test probability (PTP) for CAD (low, intermediate, and high). Furthermore, we compared the CAC score with exercise electrocardiography (ECG) and compared both tests with coronary angiography.

Methods and results: We retrospectively identified patients with angina and/or dyspnea for whom CAC score was used to increase or decrease the likelihood of CAD. Of 882 patients, majority had low (45%) or intermediate (44%) PTP. Patients with higher PTP had significantly higher CAC scores (Cramer's V = 0.29, p < 0.0001). Most patients (57%) had a CAC score of zero, especially those with low (73%) and intermediate (49%) PTP. However, 20% of patients with high PTP had CAC score of zero. Higher CAC scores were observed in patients with abnormal exercise ECG, but association was weak and not significant (Cramer's V = 0.13, p = 0.08). Moreover, more than 40% of patients with an abnormal exercise ECG had CAC score of zero. Higher CAC scores were associated with more severe abnormalities on coronary angiography (Cramer's V = 0.43, p < 0.0001), whereas there was no association between results of exercise ECG and coronary angiography (Cramer's V = 0.11, p = 0.91).

Conclusion: CAC score can be used in addition to PTP to increase or decrease the likelihood of CAD, and it might be more useful than exercise ECG in the diagnostic work-up of chest pain.

Keywords: CT; angina; cardiovascular disease; coronary artery disease; risk factors; stable.

MeSH terms

Calcium*
Coronary Angiography
Coronary Artery Disease* / diagnostic imaging
Humans
Retrospective Studies

Substances

Calcium

Grants and funding

The manuscript was funded by an unrestricted grant provided by the Tergooi Academy, Tergooi Medical Center, the Netherlands, for the PhD project of the main author, M. Patrick Witvliet.