What is the role of coronary computed tomography angiography (CCTA) in determining the calcium score?

Updated: Dec 21, 2017
  • Author: Eugene C Lin, MD; Chief Editor: Eugene C Lin, MD  more...
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Answer

Calcium scoring and coronary computed tomography (CT) angiography (CCTA) have different clinical indications. Calcium scoring is primarily used for risk stratification of asymptomatic patients, while CCTA is primarily used in patients with acute or chronic chest pain. One potential use of performing a nonenhanced calcium scoring study before a CCTA is to decide whether to proceed with CCTA in patients with extensive coronary calcium. There is no established calcium score cutoff value above which CCTA will not be diagnostic, but a score of 1000 is often used.

In the multicenter Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography (ACCURACY) trial, [12] the specificity of CCTA was significantly reduced (from 86% to 53%) in patients with calcium scores greater than 400. However, in a meta-analysis of 51 studies [13] published in 2012, the accuracy of CCTA for significant stenoses was high, even in cases of severe coronary calcification, as long as 64-slice or new CT systems were used.

In symptomatic patients with low-to-intermediate pretest probability of coronary artery disease (CAD) (the categories for which CCTA has been endorsed), a negative coronary CTA shows a very high negative predictive value, independent of the coronary calcium score. In addition, the calcium score does not influence the result of the CCTA when it is considered positive for obstructive CAD. [14]


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