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Calcium scoring and chest pain: Is it dead on arrival?
MedLine Citation:
PMID:  21067988     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Coronary artery calcium (CAC) scoring has been shown to be a measure of overall coronary artery disease (CAD) burden and is a well-validated screening test that significantly improves cardiovascular risk prediction in asymptomatic adults beyond that provided with standard risk factors. The absence of coronary artery calcification identifies persons at very low cardiovascular risk. Among symptomatic patients, calcium scans have been shown to have high sensitivity for the presence of obstructive CAD among stable, low-intermediate risk middle-aged adults. This has prompted many to advocate for the expanded use of calcium scanning as a diagnostic test in symptomatic patients to rapidly identify patients without CAD, serving as a filter for invasive coronary angiography or hospital admission or both. However, recent studies suggest that the negative predictive value of CAC scoring to exclude obstructive CAD may be significantly decreased among patients at higher pretest likelihood for obstructive CAD, consistent with Bayesian reasoning. In a point-counterpoint format, this article discusses several considerations and potential limitations to the widespread use of CAC to exclude obstructive CAD in symptomatic patients which include (1) the effect of pretest disease prevalence on test accuracy, (2) limited clinical efficiency due to low specificity for obstructive CAD and myocardial ischemia and high background prevalence of CAC in adults, (3) occurrence of CAC relatively late in the atherosclerotic process, (4) lack of association of CAC with vulnerable and culprit coronary artery lesions, and (5) interindividual and racial heterogeneity in the process of atherosclerosis calcification.
Authors:
Todd C Villines; Salvatore Carbonaro; Eddie Hulten
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Publication Detail:
Type:  Journal Article     Date:  2010-10-26
Journal Detail:
Title:  Journal of cardiovascular computed tomography     Volume:  5     ISSN:  1876-861X     ISO Abbreviation:  J Cardiovasc Comput Tomogr     Publication Date:    2011 Jan-Feb
Date Detail:
Created Date:  2011-02-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101308347     Medline TA:  J Cardiovasc Comput Tomogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  30-4     Citation Subset:  IM    
Copyright Information:
Published by Elsevier Inc.
Affiliation:
Cardiology Service, Walter Reed Army Medical Center, Building 2, Room 4A-34A, 6900 Georgia Avenue, NW, Washington, DC 20307, USA.
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