Document Detail


Calcium score to evaluate chest pain in the emergency room.
MedLine Citation:
PMID:  23370817     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Some authors have suggested that a zero calcium score (CAC) can be used to rule out the diagnosis of acute coronary syndrome. Objective this study is to evaluate the diagnostic accuracy of a zero CAC when compared to the coronary computed tomography angiography (CCTA) at the emergency department. 135 symptomatic patients with no previous coronary heart disease (CHD) who presented to the emergency department were submitted to CAC and CCTA to rule out CHD. All patients had normal electrocardiogram and cardiac biomarkers and were TIMI risk score 0 to 2. The CCTA was considered positive if any obstructive lesion (> 50%) was identified. The mean age was 51.7 ± 13.6 years with 50.6% of men. Seventy-three (54.1%) patients had a calcium score of zero. Of them, 3 (4.1%) had an obstruction > 50 % and underwent invasive coronary angiography. Calcium score showed a sensitivity of 92.9%, specificity of 75.3%, positive and negative predictive values of, respectively, 62.9% and 95.9%. Positive and negative likelihood ratios were respectively of 3.7 and 0.09 to detect lesions greater than 50% in the CCTA. A negative likelihood ratio of 0.09 is very good to rule out most cases of significant coronary obstruction in epidemiologic studies. However, it is important to understand that in a clinical scenario, all evidence including history, clinical examination, data from eletrocardiogram and myocardial biomarkers have to be interpreted together. In our study, three cases with a zero CAC score had coronary obstruction higher than 50% at the CCTA.
Authors:
Henrique Lane Staniak; Márcio Sommer Bittencourt; Rodolfo Sharovsky; Isabela Benseñor; Rodrigo Diaz Olmos; Paulo A Lotufo
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Publication Detail:
Type:  JOURNAL ARTICLE    
Journal Detail:
Title:  Arquivos brasileiros de cardiologia     Volume:  100     ISSN:  1678-4170     ISO Abbreviation:  Arq. Bras. Cardiol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-2-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0421031     Medline TA:  Arq Bras Cardiol     Country:  -    
Other Details:
Languages:  ENG; POR     Pagination:  90-93     Citation Subset:  -    
Affiliation:
Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil.
Vernacular Title:
Escore de cálcio para avaliar dor torácica na sala de emergência.
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