+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Coronary calcification by electron beam computed tomography and obstructive coronary artery disease: a model for costs and effectiveness of diagnosis as compared with conventional cardiac testing methods



Coronary calcification by electron beam computed tomography and obstructive coronary artery disease: a model for costs and effectiveness of diagnosis as compared with conventional cardiac testing methods



Journal of the American College of Cardiology 33(2): 453-462



The purpose of this study was to determine if electron beam computed tomography (EBCT) has potential as a cost-effective approach to diagnosis of obstructive coronary disease. Coronary calcification quantified by EBCT is closely related to the extent of atherosclerosis. A model based upon published sensitivities (Se)/specificities (Sp) for diagnosis in an ambulatory patient of obstructive coronary disease (> or =50% stenosis) and population prevalence was tested for angiography alone, or treadmill exercise, stress echocardiography, stress thallium or predetermined EBCT calcium score outpoints, followed by angiography if indicated. Total direct testing costs increased in proportion to disease prevalence whereas cost-effectiveness, direct costs/patient diagnosed correctly with disease, decreased as a function of prevalence. Using an EBCT calcium score of 168 (Se/Sp = 71%/90%) provided for the least costly and most cost-effective noninvasive pathway. Calcium scores of 80 (Se/Sp = 84%/84%) and 37 (Se/Sp = 90%/77%) were also cost-effective when prevalence of disease was < or =70%; but results for a >0 calcium score (Se/Sp = 95%/46%) cutpoint were not superior to conventional methods. Calcium score cutpoints of 37, 80 or 168 provided similar or superior overall negative and positive predictive values to conventional noninvasive testing pathways across all prevalence subgroups. In ambulatory patients evaluated for obstructive coronary disease, a testing pathway utilizing quantification of coronary calcium by EBCT as an initial noninvasive testing approach minimized direct costs, and maximized cost-effectiveness in population groups with low/ moderate disease prevalence (< or =70%); as expected, direct angiography as the first and only test proved most cost-effective in patients with a high prevalence (>70%) of disease.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 045651248

Download citation: RISBibTeXText

PMID: 9973026

DOI: 10.1016/s0735-1097(98)00583-x


Related references

Comparison of coronary artery calcification detected by electron beam computed tomography in coronary artery ectasia and in stenotic coronary artery disease. Zhonghua Xinxueguanbing Zazhi 32(1): 13-16, 2004

Detection of calcification by electron beam computed tomography in patients with coronary artery lesions due to Kawasaki disease Relationship between the acute coronary artery dilatation and the later appearance of calcification. Circulation 106(19 Suppl.): II-593-II-594, 2002

Relationships between coronary calcification detected at electron beam computed tomography and percutaneous transluminal coronary angioplasty results in coronary artery disease patients. European Radiology 13(1): 62-67, 2003

Electron beam computed tomography in the diagnosis of obstructive coronary artery disease. Journal of the American College of Cardiology 37(2): 689-690, 2001

Diagnosis of ischemic heart disease with coronary artery calcification score by electron beam computed tomography. Clinical Calcium 14(6): 102-107, 2004

Can the degree of coronary artery calcification as determined by electron beam computed tomography be applicable for screening coronary artery disease?. European Heart Journal 19(ABST Suppl. ): 370, 1998

Coronary Artery Calcification Detected with Electron Beam Computed Tomography as a Marker for Coronary Artery Disease. Biomedical Engineering/ Biomedizinische Technik 39(S1): 207-208, 1994

Diagnostic Performance of Hybrid Cardiac Imaging Methods for Assessment of Obstructive Coronary Artery Disease Compared With Stand-Alone Coronary Computed Tomography Angiography: A Meta-Analysis. Jacc. Cardiovascular Imaging 11(4): 589-599, 2018

The progression of atherosclerosis in accelerated in patients with obstructive coronary artery disease in comparison to non-obstructive coronary artery disease Evaluation by electron beam computed tomography. European Heart Journal 19(ABST Suppl. ): 126, 1998

Detecting coronary calcification with electron beam computed tomography: its role in managing coronary artery disease. Western Journal of Medicine 171(5-6): 338-340, 2000

Electron Beam Computed Tomography and Coronary Artery Disease: Scanning for Coronary Artery Calcification. Mayo Clinic Proceedings 71(4): 369-377, 1996

Electron beam computed tomography and coronary artery disease: Scanning for coronary artery calcification. Mayo Clinic Proceedings 71(4): 369-377, 1996

Cost-effectiveness of electron-beam computed tomography in the diagnosis of coronary artery disease. Archives of Internal Medicine 161(21): 2624, 2001

Electron beam computed tomography for diagnosis of coronary artery disease A cost analysis of various diagnostic testing pathways. Circulation 92(8 Suppl. ): I650, 1995

Prediction for obstructive coronary artery evaluated coronary artery calcification by electron beam computed tomographic scanning. Journal of the American College of Cardiology 29(2 Suppl. A): 517A, 1997