Coronary calcium scanning adds incremental value to patients with positive stress tests

• Published in: The American heart journal 2002-05, Vol.143 (5), p.861-867
• Main Authors: LaMont, Daniel H., Budoff, Matthew J., Shavelle, David M., Shavelle, Robert, Brundage, Bruce H., Hagar, James M.
• Format: Article
• Language: English
• Subjects: Area Under Curve; Biological and medical sciences; Calcinosis - diagnosis; Calcinosis - diagnostic imaging; Cardiology. Vascular system; Cardiovascular disease; Coronary Artery Disease - diagnosis; Coronary Artery Disease - diagnostic imaging; Coronary Disease - diagnosis; Coronary Disease - diagnostic imaging; Coronary heart disease; Coronary vessels; Diabetes; Diagnosis, Differential; False Positive Reactions; Family medical history; Female; Fitness equipment; Heart; Heart attacks; Heart Function Tests; Heart surgery; Humans; Hypertension; Male; Medical imaging; Medical sciences; Middle Aged; Patient Selection; Regression Analysis; Reproducibility of Results; Sensitivity and Specificity; Studies; Tomography, X-Ray Computed; Veterans
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1067/mhj.2002.120972

Background The sensitivity of coronary calcification by electron beam tomography (EBT) for the detection of coronary atherosclerosis is well-established. Combining the anatomic information of EBT with the functional information of stress testing might reduce the high false-positive result rate seen with treadmill stress test (TMST) alone. No studies have reported the additive value of a negative EBT result (no coronary calcium) for excluding obstructive coronary artery disease (OCAD) in patients with a positive TMST result. This study evaluated the negative predictive value and potential clinical utility of EBT to identify patients with a falsely abnormal TMST. Methods A coronary calcium score was determined by EBT for 153 symptomatic patients who underwent coronary angiography because of a positive TMST. The sensitivity, specificity, and predictive values of EBT were determined. A multiple logistic regression analysis compared conventional cardiac risk factors with coronary calcification by EBT for predicting OCAD. A receiver operating characteristic curve was generated plotting sensitivity versus false-positive rate. Results The false-positive rate of the TMST compared with angiography was 27% (41 of 153). The sensitivity of a nonzero coronary calcium score for OCAD was 98% (110 of 112), with a negative predictive value of 93%. According to multiple logistic regression, coronary calcification by EBT was a stronger predictor of OCAD than any conventional cardiac risk factor. EBT calcium added incremental value to the results of the TMST. Receiver operating characteristic curve analysis found an area under the curve of 0.91 (P