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Comparison of electron beam computed tomography scanning and conventional risk factor assessment for the prediction of angiographic coronary artery disease

Alan D. Guerci, MD, FACC^*, Louise A. Spadaro, MD, FACC^*, Ken J. Goodman, MD, Alfonso Lledo-Perez, MD, David Newstein, MS^*, Gail Lerner, MS^* and Yadon Arad, MD^*

^* Research Department, St. Francis Hospital, Roslyn, New York, USA
Department of Radiology, St. Francis Hospital, Roslyn, New York, USA

View larger version (22K): [in a new window]   Figure 1 Box and whisker plot of the distribution of coronary calcium scores for patients with angiographically normal coronary arteries (n = 98), angiographic nonobstructive coronary disease (n = 76) or angiographic obstructive disease (n = 116). The horizontal line inside the rectangular segment of each box denotes the median value for each category of disease. The lower and upper edges of the rectangular segment represent the 25th and 75th percentiles of the distribution of calcium scores and the flared ends of each box represent the 10th and 90th percentiles. The whiskers encompass the entire range of each population.

View larger version (21K): [in a new window]   Figure 2 Sensitivity and specificity of electron beam CT scanning for the detection of any angiographic coronary disease. Values for sensitivity and specificity are presented as a function of the square root of the coronary calcium score. The sum of sensitivity and specificity were maximized at a calcium score of 80.

View larger version (22K): [in a new window]   Figure 3 Sensitivity and specificity of electron beam CT scanning for the detection of any angiographic obstructive coronary disease. Values for sensitivity and specificity are presented as a function of the square root of the coronary calcium score. The sum of sensitivity and specificity were maximized at a calcium score of 170.

View larger version (21K): [in a new window]   Figure 4 Percentage of patients with any coronary disease as a function of the number of risk factors and the coronary calcium score. Solid bars refer to patients with calcium scores 80; open bars refer to patients with calcium scores <80. Numbers at the top of each bar refer to the number of patients in each group. The likelihood of any coronary disease was independent of the number of risk factors for patients with calcium scores 80, whereas the likelihood of any coronary disease was related to the number of risk factors for those with calcium scores <80. The value of p refers to the difference between the likelihood of disease among those with calcium scores above and below 80, after adjustment for the number of risk factors. p < 0.001.

View larger version (18K): [in a new window]   Figure 5 Percentage of patients with obstructive coronary disease as a function of the number of risk factors and the coronary calcium score. Solid bars refer to patients with calcium scores 170; open bars refer to patients with calcium scores <170. Numbers at the top of each bar refer to the number of patients in each group. No patient with obstructive disease had no risk factors. Interpretation as in Figure 2. p < 0.001.