A minimal coronary artery calcium score alone does not reliably detect significant stenoses in patients presenting to the emergency department with chest pain, according to a study presented at the recent American College of Cardiology (ACC) meeting in Atlanta.
Dr. Michael Gallagher and colleagues from the William Beaumont Hospital in Royal Oak, MI, tested whether CT angiography (CTA) would add incremental information compared to coronary artery calcium testing.
They prospectively evaluated 169 patients who presented to the hospital's emergency department with chest pain and low thrombolysis in myocardial infarction (TIMI) with defined risk scores of 3 or less. The average TIMI score was 1.
All patients underwent 64-slice coronary CTA with or without stress nuclear testing. Coronary calcium score was evaluated by two independent observers and graded into quartiles.
Overall, 80% of the patients had a coronary calcium score of less than 20. Of the 26 patients who underwent cardiac catheterization (15.4%), significant coronary artery disease was found in 9.5%. Twelve received a stent while another two had a coronary artery bypass graft and two received medical therapy alone.
Eight of the patients found to have coronary artery disease at catheterization had coronary calcium scores less than 100. Noncalcified plaques were found in 21 of the 169 patients (12.4%) and not all underwent catheterization.
"Negative calcium scan alone failed to detect culprit stenoses in three out of 16 patients with catheterization-proven significant coronary artery disease," Gallagher said. "Coronary CT does provide incremental information compared with coronary calcium alone." She cautioned, however, that the study's small sample size was small, and that patient management was not protocol-driven.
By Crystal Phend
AuntMinnie.com contributing writer
April 5, 2006
Related Reading
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ACC study says 64-slice CTA saves money, March 16, 2006
Researchers look at therapeutic US for myocardial reperfusion, March 7, 2005
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