The Effectiveness of Calcium Scoring Alongside Coronary Computed Tomography Angiography in Patients with Low-Likelihood of Chest Pain

Acute chest pain is a challenging clinical problem, commonly encountered in emergency departments. Appropriate management and treatment of acute chest pain requires a careful assessment of patients to predict the probability of acute coronary syndrome (ACS) and initiate immediate treatment. Generally low-risk patients with negative serial electrocardiograms and cardiac injury markers have to undergo a confirmatory test so that the presence of underlying ischemia and also the need for hospitalization might be established (1). Non-invasive imaging studies are being increasingly used with such patients and Coronary Computed Tomography Angiography (CCTA) has been proven instrumental in assisting the physicians to decide about the likelihood of ACS. Hoffmann et al. (2009) explored the effectiveness of CCTA in patients with acute chest pain and normal electro-cardiograms and cardiac biomarkers. In their sample, the patients who had no plaque on CCTA did not have ACS in the follow-up either, so that the negative results on CCTA had 100% negative predictive value for ACS (2). CT quantification of CAC (coronary artery calcification) was used to exclude ischemia (3). The results that the study yielded indicated that CAC scoring could be performed to assess the need for hospitalization in low risk patients. Nonexistent or minimal CAC would make cardiac chest pain very unlikely in the patients with low to moderate probability of coronary chest pain. (3) CCTA together with CT CAC scoring is another protocol used to detect ACS, even though there is some evidence suggesting that combining these two methods might lead to no particular advantages (4, 5). CCTA could be more helpful than CAC scoring in predicting major cardiac adverse events in low risk patients in emergency departments, and that using both methods simultaneously might not increase the prognostic value of CCTA, when done alone (4). Chang et al. investigated the effect of adding CAC scoring to CCTA. The results suggested that elevated CAC score is linked with a higher likelihood of underlying coronary artery disease on CCTA, but it does not assist the CCTA in predicting 30-day adverse cardiovascular events (5). Drawing on the findings mentioned above, we studied the patients who shown up in our emergency department with acute chest pain in a one-year period. It was found that patients with low likelihood chest pain, 2088 patients had undergone coronary CCTA in addition to CT CAC scoring. With the cost of the addition of CAC scoring to CCTA being 133 dollars for …