Detection of coronary artery calcium by ultrafast computed tomography and its relation to clinical evidence of coronary artery disease.

Ultrafast computed tomography (CT) was used to evaluate the relation of coronary artery calcium, a marker of atherosclerosis, with a reported history of coronary artery disease (CAD) in 928 men and 290 women (mean age 53 +/- 10 years; 11% with previous CAD). Total calcium score was calculated as the sum of each lesion-specific score, calculated as the product of pixel area and density > 130 Hounsfeld units. Total score was 3 to 6 times greater (p < 0.01) and the probability of coronary artery calcium 30 to 40% greater (p < 0.01) in patients with a reported history of myocardial infarction, positive angiography, bypass surgery or angioplasty. From score cutoffs ranging from 1 to 500 for defining calcium, a negative test was accurate 93 to 98% of the time in ruling out CAD, whereas specificity increased from 43 to 93%; however, sensitivity decreased from 92 to 42%. A score cutoff of 50 showed modest sensitivity (78%) and specificity (71%); however, the predictive value for CAD from a positive test remained low (< or = 40%), regardless of score cutoff. From multiple logistic regression, total score was also an independent indicator of CAD after considering any effects due to age, sex and other CAD risk factors. Further study is needed to document the long-term prognostic use of coronary calcium screening, including criteria that best project future risk of CAD.