Rotterdam Erasmus Medical Centre, department of Cardiology, The Netherlands.
Int J Cardiol. 2013 Feb 20;163(2):190-5. doi: 10.1016/j.ijcard.2011.06.002. Epub 2011 Sep 9.
Although conventional (CAG) and computed tomography angiography (CTA) are reliable diagnostic modalities for exclusion of obstructive coronary artery disease (CAD), they are costly and with considerable exposure to radiation and contrast media. We compared the accuracy of coronary calcium scanning (CCS) and exercise electrocardiography (X-ECG) as less expensive and non-invasive means to rule out obstructive CAD.
In a rapid-access chest pain clinic, 791 consecutive patients with stable chest pain were planned to undergo X-ECG and dual-source CTA with CCS. According to the Duke pre-test probability of CAD patients were classified as low (<30%), intermediate (30-70%) or high risk (>70%). Angiographic obstructive CAD (>50% stenosis by CAG or CTA) was found in 210/791 (27%) patients, CAG overruling any CTA results.
Obstructive CAD was found in 12/281 (4%) patients with no coronary calcium and in 73/319 (23%) with a normal X-ECG (p<0.001). No coronary calcium was associated with a substantially lower likelihood ratio compared to X-ECG; 0.11, 0.13 and 0.13 vs. 0.93, 0.55 and 0.46 in the low, intermediate and high risk group. In low risk patients a negative calcium score reduced the likelihood of obstructive CAD to less than 5%, removing the need for further diagnostic work-up. CCS could be performed in 754/756 (100%) patients, while X-ECG was diagnostic in 448/756 (59%) patients (p<0.001).
In real-world patients with stable chest pain CCS is a reliable initial test to rule out obstructive CAD and can be performed in virtually all patients.
虽然传统的冠状动脉造影（CAG）和计算机断层扫描血管造影（CTA）是可靠的诊断方法，可以排除阻塞性冠状动脉疾病（CAD），但它们成本高昂，且辐射和造影剂暴露量较大。我们比较了冠状动脉钙扫描（CCS）和运动心电图（X-ECG）的准确性，这两种方法更经济实惠且无创，可以排除阻塞性 CAD。
在快速通道胸痛诊所中，连续 791 例稳定型胸痛患者计划接受 X-ECG 和双源 CTA 联合 CCS。根据杜克 CAD 预测概率，患者被分为低危（<30%）、中危（30-70%）或高危（>70%）。根据 CAG 或 CTA 发现的血管造影阻塞性 CAD（>50%狭窄），791 例患者中 210 例（27%）存在阻塞性 CAD，CAG 推翻了任何 CTA 结果。
无冠状动脉钙的患者中，有 12 例（4%）存在阻塞性 CAD，正常 X-ECG 的患者中有 73 例（23%）存在阻塞性 CAD（p<0.001）。无冠状动脉钙的患者与 X-ECG 的比值显著降低，低危、中危和高危组的比值分别为 0.11、0.13 和 0.13，与 0.93、0.55 和 0.46。在低危患者中，阴性钙评分使阻塞性 CAD 的可能性降至 5%以下，无需进一步诊断性检查。CCS 可在 754/756（100%）例患者中进行，而 X-ECG 可诊断 448/756（59%）例患者（p<0.001）。
在稳定型胸痛的实际患者中，CCS 是排除阻塞性 CAD 的可靠初始检查方法，几乎可以对所有患者进行检查。
