Background
Peripheral artery calcium scoring systems are commonly used in clinical trials to
categorize calcium severity but there are little data on their accuracy and reliability.
The purpose of this study was to investigate the accuracy and reliability of these
systems.
Methods
Angiographic, computed tomography angiography, and intravascular ultrasound (IVUS)
imaging were obtained from 47 consecutive cases sourced from a prospectively collected
database of patients undergoing femoropopliteal artery endovascular intervention.
Two independent blinded readers graded calcium severity using the Peripheral Arterial
Calcium Scoring System, Peripheral Academic Research Consortium, and Fanelli calcium
scoring systems. IVUS maximum arc of calcium and calcium length were compared between
severity grades for each scoring system. The diagnostic accuracy of each scoring system
for identifying severe calcium was calculated using the reference standard of an IVUS
maximum calcium arc ≥ 180°. Agreement testing was performed between scoring systems
and between and within observers for each system.
Results
IVUS identified calcium in 85% (42/47) of cases, compared to 68% (32/47) of cases
with angiography. There were no differences in IVUS calcium parameters between grades
of calcium for any of the scoring systems. Severe calcium was detected by IVUS in
30 cases, in 23 cases by Peripheral Arterial Calcium Scoring System (sensitivity:
73%, specificity: 33%, positive predictive value [PPV]: 83%, negative predictive value
[NPV]: 22%), in 12 cases by Peripheral Academic Research Consortium (sensitivity:
42%, specificity: 83%, PPV: 92%, NPV: 25%), and in 10 cases by Fanelli (sensitivity:
39%, specificity: 100%, PPV: 100%, NPV: 27%). Agreement between scoring systems was
weak to moderate (range: k = 0.55–0.74). Interobserver agreement was weak (k = 0.41–0.54)
and intraobserver agreement was highly variable ranging from k = 0.41 to k = 0.92.
Conclusions
The poor diagnostic accuracy and weak-to-moderate reliability of calcium scoring systems
raise doubts about the use of current calcium scoring systems for use in clinical
trials.
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Article info
Publication history
Published online: December 05, 2022
Accepted:
November 9,
2022
Received:
September 16,
2022
Footnotes
Conflict of interests: The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: This work was supported by the National Heart Foundation of Australia (Health Professional Scholarship 100,668).
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