Utility of coronary artery calcium scoring in the evaluation of patients with chest pain

Rajesh Tota-Maharaj, John W. McEvoy, Michael Blaha, Michael G. Silverman, Khurram Nasir, Roger S Blumenthal

Research output: Contribution to journalArticle

Abstract

Although coronary artery calcium (CAC) scoring has an established role in risk-stratifying asymptomatic patients at intermediate risk of coronary heart disease (CHD), its utility in the evaluation of patients with chest pain is uncertain. We conducted a literature review of articles investigating the utility of: (1) CAC scoring in elective patients with indeterminate chest pain symptoms, (2) CAC as a "gatekeeper" in the triage of patients presenting to the emergency department (ED) with chest pain, and (3) the cost-effectiveness of the use of CAC scoring in the ED. We also evaluated the predictive accuracy of the absence of CAC in a pooled analysis of applicable studies. Only studies evaluating patients classified as low or intermediate risk were included. Low to intermediate risk was established by Framingham risk scores, Thrombolysis in Myocardial Infarction scores, Diamond-Forrester classification, or by the absence of typical angina symptoms, ischemic electrocardiogram, positive cardiac biomarkers, or a prior history of CHD. In our pooled analysis, the presence of any CAC resulted in a high sensitivity (range 70%-100%) for predicting the presence of obstructive coronary disease among symptomatic patients subsequently referred for coronary angiography. More importantly, a CAC score of 0 in low-and intermediate-risk ED populations with chest pain had a high negative predictive value (99.4%) for CHD events over an average follow-up of 21 months. CAC scoring also seems cost-effective in this population. Although further research is needed, carefully selected ED patients with a normal electrocardiogram, normal cardiac biomarkers, and CAC = 0 may be considered for early discharge without further testing.

Original languageEnglish (US)
Pages (from-to)99-106
Number of pages8
JournalCritical Pathways in Cardiology
Volume11
Issue number3
DOIs
StatePublished - Sep 2012

Fingerprint

Chest Pain
Coronary Vessels
Calcium
Coronary Disease
Hospital Emergency Service
Electrocardiography
Biomarkers
Diamond
Triage
Coronary Angiography
Population
Cost-Benefit Analysis
Myocardial Infarction
Costs and Cost Analysis
Research

Keywords

  • CAC score
  • chest pain
  • chest pain algorithms
  • emergency room chest pain triage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Utility of coronary artery calcium scoring in the evaluation of patients with chest pain. / Tota-Maharaj, Rajesh; McEvoy, John W.; Blaha, Michael; Silverman, Michael G.; Nasir, Khurram; Blumenthal, Roger S.

In: Critical Pathways in Cardiology, Vol. 11, No. 3, 09.2012, p. 99-106.

Research output: Contribution to journalArticle

Tota-Maharaj, Rajesh ; McEvoy, John W. ; Blaha, Michael ; Silverman, Michael G. ; Nasir, Khurram ; Blumenthal, Roger S. / Utility of coronary artery calcium scoring in the evaluation of patients with chest pain. In: Critical Pathways in Cardiology. 2012 ; Vol. 11, No. 3. pp. 99-106.
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