European Radiology

, Volume 19, Issue 9, pp 2127–2135 | Cite as

Coronary calcium score as gatekeeper for 64-slice computed tomography coronary angiography in patients with chest pain: per-segment and per-patient analysis

  • Anselmo Alessandro Palumbo
  • Erica Maffei
  • Chiara Martini
  • Giuseppe Tarantini
  • Gian Luca Di Tanna
  • Elena Berti
  • Roberto Grilli
  • Giancarlo Casolo
  • Valerio Brambilla
  • Marcella Cerrato
  • Antonio Rotondo
  • Annick C. Weustink
  • Nico R. A. Mollet
  • Filippo Cademartiri


We sought to investigate the performance of 64-slice CT in symptomatic patients with different coronary calcium scores. Two hundred patients undergoing 64-slice CT coronary angiography for suspected coronary artery disease were enrolled into five groups based on Agatston calcium score using the Mayo Clinic risk stratification: group 1: score 0, group 2: score 1–10, group 3: score 11–100, group 4: score 101–400, and group 5: score > 401. Diagnostic accuracy for the detection of significant (≥50% lumen reduction) coronary artery stenosis was assessed on a per-segment and per-patient base using quantitative coronary angiography as the gold standard. For groups 1 through 5, sensitivity was 97, 96, 91, 90, 92%, and specificity was 99, 98, 96, 88, 90%, respectively, on a per-segment basis. On a per-patient basis, the best diagnostic performance was obtained in group 1 (sensitivity 100% and specificity 100%) and group 5 (sensitivity 95% and specificity 100%). Progressively higher coronary calcium levels affect diagnostic accuracy of CT coronary angiography, decreasing sensitivity and specificity on a per-segment base. On a per-patient base, the best results in terms of diagnostic accuracy were obtained in the populations with very low and very high cardiovascular risk.


Coronary angiography Calcium score Cardiovascular risk Mayo Clinic classification Multislice computed tomography 


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Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • Anselmo Alessandro Palumbo
    • 1
    • 2
  • Erica Maffei
    • 1
  • Chiara Martini
    • 1
  • Giuseppe Tarantini
    • 3
  • Gian Luca Di Tanna
    • 4
  • Elena Berti
    • 4
  • Roberto Grilli
    • 4
  • Giancarlo Casolo
    • 5
  • Valerio Brambilla
    • 6
  • Marcella Cerrato
    • 7
  • Antonio Rotondo
    • 7
  • Annick C. Weustink
    • 2
  • Nico R. A. Mollet
    • 2
  • Filippo Cademartiri
    • 1
    • 2
  1. 1.Department of Radiology and CardiologyAzienda Ospedaliero-Universitaria di Parma, Non-Invasive Cardiovascular ImagingParmaItaly
  2. 2.Department of Radiology and CardiologyErasmus Medical CenterRotterdamThe Netherlands
  3. 3.Department of CardiologyUniversity of PaduaPaduaItaly
  4. 4.Regional Health Agency, Regione Emilia RomagnaBolognaItaly
  5. 5.Department of CardiologyOspedale VersiliaViareggioItaly
  6. 6.Cardiovascular Rehabilitation UnitDon Gnocchi ONLUSParmaItaly
  7. 7.Department of RadiologyUniversity of NaplesNaplesItaly

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