Evidence map›Paper›PMID 33775584›Full record

ArticleJournal of cardiovascular computed tomography

The accuracy of coronary CT angiography in patients with coronary calcium score above 1000 Agatston Units: Comparison with quantitative coronary angiography.

Alan C Kwan, Heidi Gransar, Evangelos Tzolos, Billy Chen, Yuka Otaki, Eyal Klein, Adele J Pope, Donghee Han, Andrew Howarth, Nishita Jain and 5 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of cardiovascular computed tomography. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed
3.1field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 40 citations in OpenAlex.

  1. Article
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  7. Cardiac imaging using photon counting CT - benefits, challenges and prospects.The international journal of cardiovascular imaging · 2026
    Review
  8. Review
  9. Article
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  11. Sex-Specific Coronary Artery Calcium Score Threshold Predictive of Obstructive Coronary Artery Disease.Journal of the Society for Cardiovascular Angiography & Interventions · 2026
    Article
  12. Review
  13. Article
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  18. [The challenging patient-recommendations and solutions].Radiologie (Heidelberg, Germany) · 2024
    Review
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 2 institutions in 3 countries.

Alan C KwanDepartment of Imaging, Medicine, Smidt Heart Institute, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
Heidi GransarDepartment of Imaging, Medicine, Smidt Heart Institute, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
Evangelos TzolosDepartment of Imaging, Medicine, Smidt Heart Institute, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA; BHF Centre for Cardiovascular Science, University of Edinburgh,Edinburgh,United Kingdom, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
Billy ChenDepartment of Imaging, Medicine, Smidt Heart Institute, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
Yuka OtakiDepartment of Imaging, Medicine, Smidt Heart Institute, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
Eyal KleinDepartment of Imaging, Medicine, Smidt Heart Institute, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
Adele J PopeDepartment of Imaging, Medicine, Smidt Heart Institute, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
Donghee HanDepartment of Imaging, Medicine, Smidt Heart Institute, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
Andrew HowarthDepartment of Imaging, Medicine, Smidt Heart Institute, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA; Department of Cardiac Sciences, University of Calgary,Calgary AB,Canada, 2500, University Dr. NW, Calgary, Alberta, T2N 1N4, Canada.
Nishita JainDepartment of Imaging, Medicine, Smidt Heart Institute, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
Damini DeyDepartment of Imaging, Medicine, Smidt Heart Institute, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
Robert Jh MillerDepartment of Imaging, Medicine, Smidt Heart Institute, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA; Department of Cardiac Sciences, University of Calgary,Calgary AB,Canada, 2500, University Dr. NW, Calgary, Alberta, T2N 1N4, Canada.
Victor ChengDepartment of Cardiology and Cardiovascular Imaging, Minneapolis Heart Institute, Minneapolis, MN, 800 E 28th St, Minneapolis, MN, 55407, USA.
Babak AzarbalDepartment of Imaging, Medicine, Smidt Heart Institute, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
Daniel S BermanDepartment of Imaging, Medicine, Smidt Heart Institute, and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA. Electronic address: Daniel.berman@cshs.org.
Cedars-Sinai Medical Center · USMinneapolis Heart Institute Foundation · US

Funding

Training in Advanced Heart Disease ResearchT32HL116273 · NHLBI · CEDARS-SINAI MEDICAL CENTER · PI Joshua I Goldhaber, EDUARDO MARBAN · 2013 to 2026
$5.6M
Doris Duke Charitable Foundation 2020059NHLBI NIH HHS T32 HL116273
6 · The paper itself

Abstract

backgroundHigh amounts of coronary artery calcium (CAC) pose challenges in interpretation of coronary CT angiography (CCTA). The accuracy of stenosis assessment by CCTA in patients with very extensive CAC is uncertain.

methodsRetrospective study was performed including patients who underwent clinically directed CCTA with CAC score >1000 and invasive coronary angiography within 90 days. Segmental stenosis on CCTA was graded by visual inspection with two-observer consensus using categories of 0%, 1-24%, 25-49%, 50-69%, 70-99%, 100% stenosis, or uninterpretable. Blinded quantitative coronary angiography (QCA) was performed on all segments with stenosis ≥25% by CCTA. The primary outcome was vessel-based agreement between CCTA and QCA, using significant stenosis defined by diameter stenosis ≥70%. Secondary analyses on a per-patient basis and inclusive of uninterpretable segments were performed.

results726 segments with stenosis ≥25% in 346 vessels within 119 patients were analyzed. Median coronary calcium score was 1616 (1221-2118). CCTA identification of QCA-based stenosis resulted in a per-vessel sensitivity of 79%, specificity of 75%, positive predictive value (PPV) of 45%, negative predictive value (NPV) of 93%, and accuracy 76% (68 false positive and 15 false negative). Per-patient analysis had sensitivity 94%, specificity 55%, PPV 63%, NPV 92%, and accuracy 72% (30 false-positive and 3 false-negative). Inclusion of uninterpretable segments had variable effect on sensitivity and specificity, depending on whether they are considered as significant or non-significant stenosis.

conclusionsIn patients with very extensive CAC (>1000 Agatston units), CCTA retained a negative predictive value ​> ​90% to identify lack of significant stenosis on a per-vessel and per-patient level, but frequently overestimated stenosis.

Indexed as

Coronary Artery DiseaseCoronary StenosisCalciumComputed Tomography AngiographyCoronary AngiographyHumansPredictive Value of TestsRetrospective StudiesCalciumAccuracyCoronary artery calciumCoronary calcium scoreCoronary CT angiographyQuantitative coronary angiographyStenosis

Identifiers

PMID33775584
PMCPMC8403134
OpenAlexW3138007539

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.