Diagnostic and Prognostic Value of Coronary Computed Tomography Angiography in Patients with Severe Calcification


Our aim was to analyze its diagnostic and prognostic value in patients with high coronary calcium score (CCS). A total of 113 patients with CCS > 400 were included. Significant coronary artery disease (CAD) was defined as stenosis ≥ 50%. Invasive coronary angiography and major cardiovascular events were recorded. The CCS and heart rate during the acquisition were significantly lower in the diagnostic coronary computed tomography angiography (CCTA) group. The cut-off value of CCS to establish the diagnostic utility of CCTA was 878. The rate of cardiovascular events was 9.3%. The positive predictive value of CCTA to detect significant CAD was 73.5% and the negative predictive value for predicting cardiovascular events was 96%. In patients with high CCS, CCTA is useful to evaluate CAD, especially when the CCS is lower or equal to 878; moreover, the prognostic value of CCTA is better in patients where significant CAD has been ruled out.

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Coronary computed tomography angiography


Coronary calcium score


Coronary artery disease


Significant coronary artery disease


Cardiovascular risk factors


Standard deviation


Major adverse cardiovascular events


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Laura Fernández-Friera was acknowledged for her work in the follow-up of patients.


This study was supported by Comunidad de Madrid through the programme AORTASANA-CM; B2017/BMD-3676 co-financed by the European Social Fund (ESF).

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Correspondence to Leticia Fernández-Friera.

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All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Clinical Relevance of the Manuscript

We have shown that CCTA is useful for evaluating CAD in almost 90% of patients with extensive coronary calcification, especially if the CCS is lower or equal to 878 and the heart rate is optimized. Cardiovascular events are lower when CCTA excluded CADs, which provides prognostic value in the medium term. Thus, a high CCS should, therefore, not be considered as a contraindication for CCTA.”

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Díaz-Antón, B., Solís, J., Morales, R.D. et al. Diagnostic and Prognostic Value of Coronary Computed Tomography Angiography in Patients with Severe Calcification. J. of Cardiovasc. Trans. Res. 14, 131–139 (2021). https://doi.org/10.1007/s12265-020-09977-4

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  • Coronary calcium score
  • Non-invasive coronary angiography
  • Coronary computed tomography angiography