Background: The coronary artery calcium (CAC) score can be used to increase (CAC score > 0) or decrease (CAC score = 0) the likelihood of coronary artery disease (CAD). We compared the CAC score with the pre-test probability (PTP) for CAD (low, intermediate, and high). Furthermore, we compared the CAC score with exercise electrocardiography (ECG) and compared both tests with coronary angiography.

Methods And Results: We retrospectively identified patients with angina and/or dyspnea for whom CAC score was used to increase or decrease the likelihood of CAD. Of 882 patients, majority had low (45%) or intermediate (44%) PTP. Patients with higher PTP had significantly higher CAC scores (Cramer's V = 0.29, < 0.0001). Most patients (57%) had a CAC score of zero, especially those with low (73%) and intermediate (49%) PTP. However, 20% of patients with high PTP had CAC score of zero. Higher CAC scores were observed in patients with abnormal exercise ECG, but association was weak and not significant (Cramer's V = 0.13, = 0.08). Moreover, more than 40% of patients with an abnormal exercise ECG had CAC score of zero. Higher CAC scores were associated with more severe abnormalities on coronary angiography (Cramer's V = 0.43, < 0.0001), whereas there was no association between results of exercise ECG and coronary angiography (Cramer's V = 0.11, = 0.91).

Conclusion: CAC score can be used in addition to PTP to increase or decrease the likelihood of CAD, and it might be more useful than exercise ECG in the diagnostic work-up of chest pain.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10492558PMC
http://dx.doi.org/10.2147/VHRM.S422458DOI Listing

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