Coronary angiography with flat panel digital detectors significantly increases the sensitivity for calcium detection in relation to conventional fluoroscopy: comparison of both systems with intravascular ultrasound.

Objective. To compare the sensitivity and specificity for coronary calcium detection of two fluoroscopic systems: 1) conventional system based on image intensifier chains (CONV); and 2) flat panel digital detector (FPDD) system, using intravascular ultrasound (IVUS) as the gold standard. Background. Coronary calcification represents advanced atherosclerotic disease and has implications during coronary interventions. Angiography has been reported to have low sensitivity for calcium detection compared with IVUS. Methods. Lesion calcification was assessed by two different fluoroscopic systems (FPDD and CONV), and by IVUS. Results. In two consecutive periods, a total of 200 consecutive patients were included, 100 in each group. Clinical characteristics were similar, without significant differences between groups. In the CONV group, IVUS detected calcium in 77% of cases, and angiography in 32%. Sensitivity was 41.6% and specificity 91.3%. In the FPDD group, IVUS reported calcification in 79% of patients, and angiography in 57%. Sensitivity was 72% (p < 0.0001 for comparison with CONV) and specificity was 90.4%. Conclusion. The new fluoroscopic systems, based on FPDD, considerably increase the sensitivity for calcium detection without detrimental effect on specificity.