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Coronary artery disease
Original research
Coronary calcium score in the initial evaluation of suspected coronary artery disease
  1. Eva Ringdal Pedersen1,2,
  2. Siren Hovland2,
  3. Iman Karaji1,2,
  4. Christ Berge2,
  5. Abukar Mohamed Ali2,
  6. Ole Christian Lekven2,
  7. Kier Jan Kuiper2,
  8. Svein Rotevatn2,
  9. Terje Hjalmar Larsen2,3
  1. 1 Department of Clinical Science, University of Bergen, Bergen, Norway
  2. 2 Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
  3. 3 Department of Biomedicine, University of Bergen, Bergen, Norway
  1. Correspondence to Dr Eva Ringdal Pedersen, Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; evpe{at}helse-bergen.no

Abstract

Objective We evaluated coronary artery calcium (CAC) scoring as an initial diagnostic tool in outpatients and in patients presenting at the emergency department due to suspected coronary artery disease (CAD).

Methods 10 857 patients underwent CAC scoring and coronary CT angiography (CCTA) at Haukeland University Hospital in Norway during 2013–2020. Based on CCTA, obstructive CAD was defined as at least one coronary stenosis ≥50%. High-risk CAD included obstructive stenoses of the left main stem, the proximal left ascending artery or affecting all three major vascular territories with at least one proximal segment involved.

Results Median age was 58 years and 49.5% were women. The overall prevalence of CAC=0 was 45.0%. Among those with CAC=0, 1.8% had obstructive CAD and 0.6% had high-risk CAD on CCTA. Overall, the sensitivity, specificity, positive predictive value and negative predictive value (NPV) of CAC=0 for obstructive CAD were 95.3%, 53.4%, 30.0% and 98.2%, respectively. However, among patients <45 years of age, although the NPV was high at 98.9%, the sensitivity of CAC=0 for obstructive CAD was only 82.3%.

Conclusions In symptomatic patients, CAC=0 correctly ruled out obstructive CAD and high-risk CAD in 98.2% and 99.4% of cases. This large registry-based cross-sectional study supports the incorporation of CAC testing in the early triage of patients with chest pain and as a gatekeeper to further cardiac testing. However, a full CCTA may be needed for safely ruling out obstructive CAD in the youngest patients (<45 years of age).

  • computed tomography angiography
  • cardiac catheterization
  • coronary stenosis

Data availability statement

Data may be obtained from a third party and are not publicly available. The data set analysed during the current study is available from the corresponding author upon reasonable request and consent from the Norwegian National Institute of Public Health (NIPH).

https://doi.org/10.1136/heartjnl-2022-321682

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. The data set analysed during the current study is available from the corresponding author upon reasonable request and consent from the Norwegian National Institute of Public Health (NIPH).

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    Footnotes

    • Contributors ERP and THL analysed and interpreted the data. ERP wrote the manuscript. SH, IK, CB, AMA, OCL, KJK and SR made substantial contributions to analysis and interpretation of data. ERP, SH, IK, CB, AMA, OCL, KJK and THL collected and processed the data. ERP and THL conceived and designed the study. SH, IK, CB, AMA, KJK, SR and THL edited and revised the manuscript. ERP is the guarantor of this work. All authors have approved the final version of the article.

    • Funding The study was funded by the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway, and the Western Norway Regional Health Authority, Norway (grant number: F-12164/480000368).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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