Do we really Need Coronary Calcium Scoring Prior to Contrast-enhanced Coronary Computed Tomographic Angiography? Analysis by Age and Coronary Risk Factors

Objectives:

To investigate the value of coronary calcium scoring (CCS) as a gatekeeper prior to coronary computed tomography angiography (CCTA).

Background:

CCTA increasingly gains importance for the detection of coronary artery disease (CAD). In general CCS is performed prior to CCTA in order to identify patients with heavily calcified vessels, where CCTA is not expected to provide diagnostic results. However, both CCS and CCTA are associated with radiation exposure for the patients.

Methods:

Between January 2008 and April 2011, 732 consecutive patients underwent CCTA for suspected or known CAD using 64-slice (n=130) or 256-slice CT scanners (n=602). Clinical parameters including age and traditional coronary risk factors were recorded at the time of the CCTA studies. CCS was performed in all patients and in those with CCS≥800, studies were discontinued, and CCTA was not performed.

Results:

CCS and CCTA were associated with a mean radiation exposure of 0.9±0.2mSv and 5.2±4.4mSv, respectively. Significant associations were noted between CCS and age (r=0.30, p

Conclusion:

Although calcium scoring is generally recommended prior to CCTA, its value as a gatekeeper is limited in younger patients with intermediate risk profile. Avoiding CCS scans using simple algorithms based of patient's age and clinical risk profiling, may be a useful simple approach, which together with current dose optimization strategies can contribute to further dose reduction with cardiac CT studies.