(Circulation. 2000;102:380.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Probabilistic Model for Prediction of Angiographically Defined Obstructive Coronary Artery Disease Using Electron Beam Computed Tomography Calcium Score Strata
From the Department of Epidemiology, University of Michigan, Ann Arbor (L.F.B., P.A.P.), and the Division of Cardiovascular Diseases (J.A.R., R.S.S.) and Department of Diagnostic Radiology (P.F.S.), Mayo Clinic and Foundation, Rochester, Minn. Dr Rumberger is currently at HeartCare Inc, Gahanna, Ohio, and is Professor of Medicine in the Department of Cardiology, Ohio State University, Columbus.
Background—Electron beam CT
(EBCT) is an accurate, noninvasive method to detect and quantify
coronary artery calcification, a marker of coronary
artery disease (CAD). This investigation examined the accuracy of EBCT
to detect obstructive CAD (
50% stenosis) and determined the
optimal strata for quantity of coronary artery calcification to
facilitate clinical decision-making.
Methods and Results—Clinical research patients (n=213) were
examined with coronary angiography and EBCT (angiography
group), and 765 research participants were examined with only EBCT
(nonangiography group). Of the angiography group, 53% had obstructive
CAD. After adjustment for verification bias, the estimated sensitivity
and specificity for calcium score 1 were 97.0% and 72.4%,
respectively. Likelihood ratios for strata of calcium score associated
with obstructive CAD were calculated in each sex and 2 age groups.
Among those 50 years old, the same 4 strata of EBCT calcium scores
were identified in each sex; likelihood ratios ranged from 0.03
(calcium score 0) to 12.85 (calcium score 200). The same 3 strata of
EBCT calcium scores were identified in each sex among those <50 years
old; likelihood ratios ranged from 0.13 (calcium score 0) to 190
(calcium score 100).
Conclusions—A calcium score 200 among those 50 years old and
calcium score 100 among those <50 years old provided strong evidence
that patients of either sex had obstructive CAD. A calcium score of 0
provided strong evidence that patients 50 years old did not have
obstructive CAD.
Key Words: coronary disease • calcium • tomography
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