The Value of Coronary Computed Tomography Angiography in Patients with a High Calcium Score

Maryam Moradi; Abbas Ali Salamatizadeh; Vahid Talebi; Mehdi Karami; Maryam Farghadani; Mohammad Javad Tarrahi; Alireza Khosravi

doi:10.18502/jthc.v18i4.14828

Maryam Moradi Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Abbas Ali Salamatizadeh Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Vahid Talebi Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Mehdi Karami Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Maryam Farghadani Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Mohammad Javad Tarrahi Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
Alireza Khosravi Hypertension Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

DOI: https://doi.org/10.18502/jthc.v18i4.14828

Keywords: Coronary artery disease; Coronary angiography; Computed tomography angiography; Calcium

Abstract

Background: We aimed to assess the agreement between coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) to determine whether patients with a high coronary artery calcium score (CS) would benefit from CCTA.

Methods: This cross-sectional study was conducted on patients suspected of having coronary artery disease. The patients underwent calcium scoring. The total CS and the number of calcified foci were determined. The calcium score index (CSI) was defined, and coronary arteries were evaluated by CCTA. ICA was performed, and reports of ICA were extracted. All the abovementioned variables were compared. For data analysis, the κ coefficient and the ROC curve were used.

Results: The study population consisted of 195 patients: 124 men (63.6%) and 71 women (36.4%). The median (IQR) value of CS was 529 (229-1042), ranging from 17 to 4717. In all 195 patients, the concordance between the final impression of CCTA and ICA was 90.2%, while the number and type of involved territories were similar at 57.9%. The highest agreement was seen in the left main and right coronary arteries, whereas the lowest agreement was detected in the left anterior descending and the left circumflex artery. The patients were categorized into different CS groups, and in those with a high CS (>1000), the agreement between CCTA and ICA concerning final impression and involved territories was similar to the whole group of patients.

Conclusion: CCTA in patients with a high CS, even exceeding 1000, remains beneficial as the noninvasive available method