Diagnostic accuracy of computed tomography coronary angiography in patients with a zero calcium score

Eur Radiol. 2010 Jan;20(1):81-7. doi: 10.1007/s00330-009-1529-9. Epub 2009 Aug 6.


To evaluate the diagnostic accuracy of 64-slice CT coronary angiography (CT-CA) for the detection of significant coronary artery stenosis in patients with zero on the Agatston Calcium Score (CACS). We enrolled 279 consecutive patients (96 male, mean age 48 +/- 12 years) with suspected coronary artery disease. Patients were symptomatic (n = 208) or asymptomatic (n = 71), and underwent conventional coronary angiography (CAG). For CT-CA we administered an IV bolus of 100 ml of iodinated contrast material. CT-CA was compared to CAG using a threshold for significant stenosis of >or=50%. The prevalence of disease demonstrated at CAG was 15% (1.4% in asymptomatic). The population at CAG showed no or non-significant disease in 85% (238/279), single vessel disease in 9% (25/279), and multi-vessel disease in 6% (16/279). Sensitivity, specificity, and positive and negative predictive values of CT-CA vs. CAG on the patient level were 100%, 95%, 76%, and 100% in the overall population and 100%, 100%, 100%, and 100% in asymptomatic patients, respectively. CT-CA proves high diagnostic performance in patients with or without symptoms and with zero CACS. The prevalence of significant disease detected by CT-CA was not negligible in asymptomatic patients. The role of CT-CA in asymptomatic patients remains uncertain.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Calcinosis / complications
  • Calcinosis / diagnostic imaging*
  • Coronary Angiography / methods*
  • Coronary Stenosis / diagnostic imaging*
  • Coronary Stenosis / etiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / methods*
  • Young Adult