Purpose: To report our clinical experience in calcium scoring and coronary angiography with multislice computer tomography (MSCT).
Material and methods: Cardiac four-row MSCT (Siemens, Volume Zoom, Erlangen, Germany) was performed in 60 patients, comprising 45 patients without known coronary vessel disease (CVD) and falling in an intermediate risk (group I) by calcium scoring, and 15 patients with multivessel disease by the combination of calcium scoring and MSCT coronary angiography (group II). Group I underwent analysis of risk factors as well as patient management in the form of risk profile modulation, indication for invasive selective coronary angiography (SCA) and supplemental myocardial diagnostic evaluation (e. g., SPECT). Agatston and volume scores (Virtuoso, Siemens, Erlangen, Germany) were calculated for calcium scoring. Group II had the calcium scoring and diagnostic accuracy of MSCT in detecting coronary artery stenosis evaluated according to established American Heart Association (AHA) criteria. SCA was used as gold standard.
Results: In group I, calcium scoring was positive in 27/45 (60 %) patients, with 14/27 (52 %) consecutively referred to SCA and 2/27 (7 %) to SPECT. SCA revealed significant coronary stenosis (> 60 %) in 5/27 (19 %) patients and SPECT detected myocardial ischemia in 0/2 patients. Patients with obstructive coronary vessel disease showed a significantly increased calcium score of > 300 together with a high risk profile. Patients with negative calcium score showed significantly less risk factors (p < 0.05). The use of calcium scoring in therapeutic procedures in the form of increased modulation of risk factors was documented in 21/45 (47 %) patients. In group II, sensitivity, specificity and diagnostic accuracy for the detection of high grade coronary artery stenosis were 64 %, 99 % and 96 %, and the Agatston and Volume scores were 333 +/- 123 and 334 +/- 136, respectively.
Conclusion: MSCT can be applied as risk profile module for coronary screening of patients with intermediate risk. As non-invasive alternative for the evaluation of coronary vessel disease, it can be useful in some cases by providing additional information.