Exclusion of Coronary Calcification with EBCT is a Safe and Effective Filter for Invasive Coronary Angiography: Results of 1764 Symptomatic Patients Ralph Haberl, Alexander Becker, Alexander Leber, Andreas Knez, Medical Hosp I, Munich, Germany; Christoph R Becker, Univ. of Munich, Munich Germany; Christine S Lang, Medical Hosp I, Munich Germany; Roland Bruening

 Background:   This monocenter study correlated the EBCT calcium score to the results of coronary angiography in 1764 symptomatic patients (1225 men, 539 women, mean age 59 ± 11 years) with atypical or typical chest pain and/or signs of myocardial ischemia in non invasive testing with unclear diagnosis, who were referred to our hospital for invasive evaluation.

 Results:     56% of men and 47% of women revealed significant coronary stenoses (>50%). No coronary calcium at all (score = 0) was found in 29.6% of the total population, and in 32% of men and 55% of women below the ages of 60 years. Exclusion of coronary calcium was associated with an extremely low probability of significant stenosis (0.7% in men and 0.0% in women). With higher scores of 20, 100 or >75% percentile of age group, sensitivity decreased to 97%, 93% and 81% respectively in men, and 98%, 82% and 76%, respectively in women. At the same time, specificity increased to 75% in men and women. The large cohort of patients allowed to calculate cutpoints of coronary calcium in different age groups separating patients with high versus low probability of significant coronary stenosis.

 Conclusion:  EBCT calcium scoring was a highly sensitive and moderately specific test to predict stenotic disease in this symptomatic study population. Exclusion of coronary calcium defines a substantial number of patients - although symptomatic - with an extremely low probability of significant stenoses, in whom invasive angiography may be omitted.