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Coronary calcium along with the lesion severity and site of lesion can be detected with good accuracy by noninvasive 64 slice CT coronary angiogram. We want to study the efficiency of fluoroscopic coronary calcium detection in guiding the location and severity of significant coronary artery stenosis, which is much cheaper, easily available with less radiation.
We recruited the patients above 60 yrs, admitted for Coronary angiogram (CAG) and detected fluoroscopic calcium on Siemen's Flat panel (with CAG setting and double magnification). We noted the type of CAD presentation, known coronary risk factors and 2D echo features. Details of CAG including the location, severity (significant coronary lesion means >50% diameter stenosis) and number of coronary vessel involvement were noted. We calculated the clinical risk score depending on type of presentation (Acute coronary syndrome -ACS as 1 or chronic stable angina -CSA as 0), Risk factor scoring (1 to 4 depending on number of risk factors) and Echo scoring (RWMA as 1 and good LV function as 0, Mild LVD as 1, moderate LVD as 2, severe LVD as 3) and combined coronary diseases predicting score ( CCDP score - by combing all three scores).
In 771 above 60 years age suspected CAD patients, 486 showed coronary calcium on fluoroscopy (63%). Average age was 67±5.8 yr with 102 females.
In 69 patients CCDP score is 0 and 417 pts CCDP score is ≥ 1. In these 69 CCDP score 0 patients, CAG showed no lesion in 20 and significant coronary lesion in 49 pts (False negative for significant CAD detection is 10.08%). In 417 pts with CCDP score ≥ 1, 28 pts does not have lesion ( False positivity is 6.7%) and 389 (80.04%) lesion was present (True positive detection rate). Coronary calcium was corresponding to the significant coronary lesion site in 268 pts(64.3%). On CAG, significant coronary lesion with calcium was present in 438 patients(90%). In these 438 patients with calcium and coronary lesion, 302 patients has lesion at the site of calcium (68%). In 49 patients (11%) the CCDP is 0 still had significant coronary lesion. So, in a pt with > 60 yr age with CCDP ≥ 1 and fluoroscopic calcium, the true positivity of the lesion is 93.3%. Not only that we can localize the site of lesion to the site of coronary calcium in 64.3% of cases.
In a suspected CAD pt with > 60 yrs age with CCDP ≥ 1, if fluoroscopic coronary calcium is detected then 93.3% of cases we can detect the significant coronary lesion with 64.3% of cases localizing the site of lesion to the site of coronary calcium.
- 2013 American College of Cardiology Foundation