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14 Calcium scores in symptomatic patients undergoing ct coronary angiograms: is there any value?

Introduction NICE guideline ‘chest pain of recent onset: assessment and diagnosis’ (CG95) recommends CT Coronary Angiography (CTCA) as the first line investigation for stable chest pain if clinically indicated. The aim is to investigate the need for a coronary artery calcium (CAC) score before CTCA. Methods Retrospective data was collected on patients who underwent both CAC and CTCA from 2016 to 2018. Patients were excluded if they had any previous intervention. Population characteristics and outcomes by year were analysed with Chi-Squared test. Clinically relevant findings were defined as >50% coronary artery stenosis or malignant aberrant courses. Relationship between age and calcium score was analysed with Spearma’s Rank, regression analysis and receiver operating characteristics (ROC). Results 1665 patients were identified and 164 were excluded, leaving 1501 patients (F=735, M=766; Range=17-94; Median=58). The proportion of clinically relevant findings were not significantly changed over the period of study (p>0.2). The proportion of normal scans has decreased from 61% in 2016 to 46% in 2018, with a corresponding increase in mild artery stenosis (p<0.0001). There is positive correlation with calcium score and age (r=0.33, p<0.0001). Regression analysis of calcium scores shows linear regression with age (R2=0.09); the cohort under 42 years had negligible calcium scores. ROC analysis shows age is predictive of calcium scores >800 (AUCage:male=0.79; AUCage:female=0.88) Conclusion There was an increase in proportion of patients with mild disease but no significant change in those with clinically relevant findings. Performing a CAC prior to CTCA for patients under 42 years old provides poor value.