Key result
Coronary calcium score accurately identifies ischemia in the RCA, reaching an AUC of ~0.89.
Why the study?
Does vessel-specific coronary calcium score correlate with FFR-CT to determine myocardial ischemia in patients undergoing CCTA?
Cross-Sectional (n=102)
No
Does vessel-specific coronary calcium score correlate with FFR-CT to determine myocardial ischemia in patients undergoing CCTA?
Effect estimate: AUC 0.89 for RCA, 0.74 for LAD, 0.66 for LCX
p-value: p=0.0009 for RCA, p=0.0003 for LAD, p=0.0156 for LCX
Vessel-specific coronary calcium score correlates significantly with FFR-CT and may be useful for deferring invasive examination, particularly in the right coronary artery where it demonstrated a 100% negative predictive value.
Background Coronary computed tomography angiography (CCTA) has been expanded as a tool for non-invasive assessment of coronary artery disease. In the past, it was standard practice to undergo the invasive fractional flow reserve (FFR) to determine the indication of coronary revascularization, however, recently it has become common to perform FFR derived from CCTA (FFR-CT) first. Previous reports demonstrated that the relationship between invasive FFR and coronary calcium score (CCS), however, little is known that the relationship between FFR-CT and CCS per vessels. We aimed to evaluate that relationship and usefulness in the consecutive patients who underwent CCTA and FFR-CT. Methods A total of 102 consecutive patients who underwent CCTA in our hospital was included in this study. The vessels with previous culprit of myocardial infarction and inability to calculate the value of FFR-CT because of artifact, previous stent deployment, and narrow vessel diameters were excluded. Finally, 87 of right coronary artery (RCA), 86 of left anterior descending artery (LAD), and 92 of left circumflex artery (LCX) were eligible for analysis in this study. FFR-CT value of 0.80 or less was defined as positive for myocardial ischemia. CCS was calculated as an Agaston Score per vessels. At that time, LAD and LCX were both included left main trunk. Results Mean CCS were 262.3±449.4 in RCA, 380.0±538.1 in LAD, and 177.1±298.2 in LCX, respectively. Mean FFR-CT were 0.89±0.10 in RCA, 0.77±0.12 in LAD, and 0.88±0.10 in LCX, respectively. Receiver operating characteristic (ROC) curve demonstrated the cut-off value to determine myocardial ischemia using CCS of RCA, LAD, and LCX were 182.2 (p=0.0009, AUC=0.89), 187.0(p=0.0003, AUC=0.74), and 209.6(p=0.0156, AUC=0.66), respectively. The cut-off value of RCA showed high negative predictive value negative predictive value (NPV) of 100%, on the other hand, those of LAD and LCX showed moderate NPV of 76% and 90%. Conclusions CCS had a significant correlation with FFR-CT and useful for deferral strategy without invasive examination, especially in RCA.Diagnostic performance of CCS
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Takami et al. (2026) conducted a cross-sectional in Coronary artery disease (n=102). Coronary calcium score vs. FFR-CT was evaluated on Myocardial ischemia defined as FFR-CT ≤0.80 (AUC 0.89 for RCA, 0.74 for LAD, 0.66 for LCX, p=p=0.0009 for RCA, p=0.0003 for LAD, p=0.0156 for LCX). Coronary calcium score significantly correlated with FFR-CT for detecting myocardial ischemia, yielding an AUC of 0.89 (P=0.0009) and 100% negative predictive value in the right coronary artery.
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