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

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

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

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

Original languageEnglish
Pages (from-to)2676-2686
Number of pages11
JournalEuropean Radiology
Volume23
Issue number10
DOIs
StatePublished - Oct 2013
Externally publishedYes

Keywords

  • Calcium score (CaSc)
  • Clinical evaluation
  • Computed tomography coronary angiography (CTCA)
  • Coronary artery disease (CAD)
  • Reclassification

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