Usefulness of cinefluoroscopic detection of coronary artery calcification in the diagnostic work-up of coronary artery disease

Abstract

Aim: To determine in which patients (cine)fluoroscopic detection of coronary artery calcifications is recommended for the diagnosis of coronary artery disease and the consequence of this finding for referral for cinecoronary arteriography. Materials and methods: Data were retrospectively obtained from 778 patients who had been referred for cinecoronary arteriography. Excluded were patients with a previous myocardial infarction, a previous abnormal cinecoronary arteriogram and patients with unstable angina. The discriminating value was assessed with the help of the crude likelihood ratio (LR), as well as the LRs stratified for gender, age and symptomatology. The gold standard was the coronary arteriogram. Furthermore, the post-test probability was estimated using logistic regression to take dependence on age, sex and symptomatology into account. Results: The crude LR of a positive and negative test result, with 95% confidence intervals, was, respectively 5.8 (4.1–8.2) and 0.52 (0.47–0.58), but was dependent on the clinical variables. Estimated probabilities of having coronary artery disease (CAD) varied substantially for a negative as well as a positive test result with the categories of clinical variables. Conclusion: (Cine)fluoroscopy discriminates between patients with and without disease; the test proved to be especially useful in females with atypical angina and patients of both sexes with non-specific chest pain.