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Erschienen in: European Radiology 10/2013

01.10.2013 | Cardiac

Restriction of the referral of patients with stable angina for CT coronary angiography by clinical evaluation and calcium score: impact on clinical decision making

verfasst von: Anoeshka S. Dharampal, Alexia Rossi, Admir Dedic, Filippo Cademartiri, Stella L. Papadopoulou, Annick C. Weustink, Bart S. Ferket, Eric Boersma, Willem B. Meijboom, Tjebbe W. Galema, Koen Nieman, Pim J. de Feyter, Gabriel P. Krestin

Erschienen in: European Radiology | Ausgabe 10/2013

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Abstract

Objective

To investigate the value of the calcium score (CaSc) plus clinical evaluation to restrict referral for CT coronary angiography (CTCA) by reducing the number of patients with an intermediate probability of coronary artery disease (CAD).

Methods

We retrospectively included 1,975 symptomatic stable patients who underwent clinical evaluation and CaSc calculation and CTCA or invasive coronary coronary angiography (ICA). The outcome was obstructive CAD (≥50 % diameter narrowing) assessed by ICA or CTCA in the absence of ICA. We investigated two models: (1) clinical evaluation consisting of chest pain typicality, gender, age, risk factors and ECG and (2) clinical evaluation with CaSc. Discrimination of the two models was compared. The stepwise reclassification of patients with an intermediate probability of CAD (10–90 %) after clinical evaluation followed by clinical evaluation with CaSc was assessed by clinical net reclassification improvement (NRI).

Results

Discrimination of CAD was significantly improved by adding CaSc to the clinical evaluation (AUC: 0.80 vs. 0.89, P < 0.001). CaSc and CTCA could be avoided in 9 % using model 1 and an additional 29 % of CTCAs could be avoided using model 2. Clinical NRI was 57 %.

Conclusion

CaSc plus clinical evaluation may be useful in restricting further referral for CTCA by 38 % in symptomatic stable patients with suspected CAD.

Key Points

CT calcium scores (CaSc) could proiritise referrals for CT coronary angiography (CTCA)
CaSc provides an incremental discriminatory value of CAD compared with clinical evaluation
Risk stratification is better when clinical evaluation is combined with CaSc
Appropriate use of clinical evaluation and CaSc helps avoid unnecessary CTCA referrals
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Metadaten
Titel
Restriction of the referral of patients with stable angina for CT coronary angiography by clinical evaluation and calcium score: impact on clinical decision making
verfasst von
Anoeshka S. Dharampal
Alexia Rossi
Admir Dedic
Filippo Cademartiri
Stella L. Papadopoulou
Annick C. Weustink
Bart S. Ferket
Eric Boersma
Willem B. Meijboom
Tjebbe W. Galema
Koen Nieman
Pim J. de Feyter
Gabriel P. Krestin
Publikationsdatum
01.10.2013
Verlag
Springer Berlin Heidelberg
Erschienen in
European Radiology / Ausgabe 10/2013
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-013-2898-7

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