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Computed tomography angiography versus Agatston score for diagnosis of coronary artery disease in patients with stable chest pain: individual patient data meta-analysis of the international COME-CCT Consortium

Schlattmann P; Zimmermann E; Knuuti J; Meijs MFL; Dubourg B; Kaufmann PA; Herzog BA; Muraglia S; Alkadhi H; Dewey M; COME-CCT Consortium; Buechel RR; Wan YL; Walther M; Ovrehus KA; Tardif JC; Norgard BL; Budoff MJ; Mickley H; Sun K; Shabestari AA; Mendoza-Rodriguez V; Halvorsen BA; Marcus RP; Bettencourt N; Leschka S; Wieske V; Diederichsen ACP; Garcia MJ; Martuscelli E; Nikolaou K

Computed tomography angiography versus Agatston score for diagnosis of coronary artery disease in patients with stable chest pain: individual patient data meta-analysis of the international COME-CCT Consortium

Schlattmann P
Zimmermann E
Knuuti J
Meijs MFL
Dubourg B
Kaufmann PA
Herzog BA
Muraglia S
Alkadhi H
Dewey M; COME-CCT Consortium
Buechel RR
Wan YL
Walther M
Ovrehus KA
Tardif JC
Norgard BL
Budoff MJ
Mickley H
Sun K
Shabestari AA
Mendoza-Rodriguez V
Halvorsen BA
Marcus RP
Bettencourt N
Leschka S
Wieske V
Diederichsen ACP
Garcia MJ
Martuscelli E
Nikolaou K
Katso/Avaa
Wieske2022_Article_ComputedTomographyAngiographyV.pdf (1.208Mb)
Lataukset: 

SPRINGER
doi:10.1007/s00330-022-08619-4
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Julkaisun pysyvä osoite on:
https://urn.fi/URN:NBN:fi-fe2022081154233
Tiivistelmä

Objectives: There is conflicting evidence about the comparative diagnostic accuracy of the Agatston score versus computed tomography angiography (CTA) in patients with suspected obstructive coronary artery disease (CAD).

Purpose: To determine whether CTA is superior to the Agatston score in the diagnosis of CAD.

Methods: In total 2452 patients with stable chest pain and a clinical indication for invasive coronary angiography (ICA) for suspected CAD were included by the Collaborative Meta-analysis of Cardiac CT (COME-CCT) Consortium. An Agatston score of > 400 was considered positive, and obstructive CAD defined as at least 50% coronary diameter stenosis on ICA was used as the reference standard.

Results: Obstructive CAD was diagnosed in 44.9% of patients (1100/2452). The median Agatston score was 74. Diagnostic accuracy of CTA for the detection of obstructive CAD (81.1%, 95% confidence interval [CI]: 77.5 to 84.1%) was significantly higher than that of the Agatston score (68.8%, 95% CI: 64.2 to 73.1%, p < 0.001). Among patients with an Agatston score of zero, 17% (101/600) had obstructive CAD. Diagnostic accuracy of CTA was not significantly different in patients with low to intermediate (1 to < 100, 100-400) versus moderate to high Agatston scores (401-1000, > 1000).

Conclusions: Results in our international cohort show CTA to have significantly higher diagnostic accuracy than the Agatston score in patients with stable chest pain, suspected CAD, and a clinical indication for ICA. Diagnostic performance of CTA is not affected by a higher Agatston score while an Agatston score of zero does not reliably exclude obstructive CAD.

Key points: • CTA showed significantly higher diagnostic accuracy (81.1%, 95% confidence interval [CI]: 77.5 to 84.1%) for diagnosis of coronary artery disease when compared to the Agatston score (68.8%, 95% CI: 64.2 to 73.1%, p < 0.001). • Diagnostic performance of CTA was not affected by increased amount of calcium and was not significantly different in patients with low to intermediate (1 to <100, 100-400) versus moderate to high Agatston scores (401-1000, > 1000). • Seventeen percent of patients with an Agatston score of zero showed obstructive coronary artery disease by invasive angiography showing absence of coronary artery calcium cannot reliably exclude coronary artery disease.

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