A zero coronary artery calcium score in patients with stable chest pain is associated with a good prognosis, despite risk of non-calcified plaques

Abstract

ObjectivesTo estimate the prevalence of non-calcified coronary artery disease (CAD) in patients with suspected stable angina and a zero coronary artery calcification (CAC) score, and to assess the prognostic significance of a zero CAC in these symptomatic patients.MethodsIn this prospective cohort study, consecutive patients with stable chest pain underwent CAC scoring ± CT coronary angiography (CTCA) as part of routine clinical care at a single tertiary centre over 7 years. Major adverse cardiac event (MACE) was defined as cardiac death, non-fatal myocardial infarction and/or non-elective revascularisation.ResultsA total of 915 of 1753 (52.2%) patients (mean age 56.8 ± 12.0 years; 46.2% male) had a zero CAC score. Of the 751 (82.1%) patients with a zero CAC in whom CTCA was performed, 674 (89.7%) had normal coronary arteries, 63 (8.4%) had non-calcified CAD with < 50% stenosis and 14 (1.9%) had ≥ 50% stenosis in at least one coronary artery. The negative predictive value of a zero CAC for excluding a ≥ 50% CTCA stenosis was 98.1%. Over a median follow-up period of 2.2 years (range 1.0–7.0 years), the absolute annualised rates of MACE were as follows: zero CAC 1.9 per 1000 person-years and non-zero CAC 7.4 per 1000 person-years (HR 3.8, p = 0.009). However, after adjusting for age, gender and cardiovascular risk factors using a multivariable Cox proportional hazards model, there was no statistically significant difference in the risk of MACE between the two patient cohorts (p = 0.19). After adjusting for age, gender and cardiovascular risk factors, the HR for all-cause mortality among the zero CAC cohort vers non-zero CAC was 2.1 (p = 0.27).ConclusionA zero CAC score in patients undergoing CT scanning for suspected stable angina has a high negative predictive value for the exclusion of obstructive CAD and is associated with a good medium-term prognosis.

A Coronary Artery Calcium Score of Zero in Patients Who Have Undergone Coronary Computed Tomography Angiography Is Associated With Freedom From Major Adverse Cardiovascular Events

“…A CACS of 0 was the strongest marker of MACE in this study. Our results are consistent with those from previous reports [2,3,14] and indicate that patients with a CACS of 0 show a good prognosis. The incidence of MACE in the present study was higher than that in previous reports [3,14].…”

“…Our results are consistent with those from previous reports [2,3,14] and indicate that patients with a CACS of 0 show a good prognosis. The incidence of MACE in the present study was higher than that in previous reports [3,14]. Kim et al reported that the incidence of MACE in CACS = 0 and CACS > 0 groups was 1.3% and 4.7% over 2.8 years, respectively [14].…”

“…Kim et al reported that the incidence of MACE in CACS = 0 and CACS > 0 groups was 1.3% and 4.7% over 2.8 years, respectively [14]. Wang et al reported their findings in patients who were followed-up for a median of 2.2 years [3]. The incidence of MACE was 0.6% in the CACS = 0 group and 2% in the CACS > 0 group.…”

“…The coronary artery calcium score (CACS) plays an important role in cardiovascular disease (CVD) risk stratification, and is significantly associated with the occurrence of major CVD events [1][2][3][4][5]. CACS is a strong predictor of coronary artery disease (CAD) [1].…”

“…Among all negative CVD risk markers, CACS of 0 was shown to be the strongest marker of CVD [2]. A CACS of 0 in patients undergoing coronary computed tomography angiography (CCTA) for suspected stable angina has a high negative predictive value for the exclusion of obstructive CAD and is associated with a good medium-term prognosis [3].…”