Influence of symptomatic status on the prevalence of obstructive coronary artery disease in patients with zero calcium score

Akram, Kamran; O’Donnell, Rachel; King, Spencer B.; Superko, H. Robert; Agatston, Arthur S.; Vörös, Szilárd

doi:10.1016/j.atherosclerosis.2008.07.008

Cited by 79 publications

(61 citation statements)

References 26 publications

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“…Moreover, zero CACS might reliably exclude obstructive CAD among older patients [16,26,29]. In contrast, none of 12 patients who had significant stenosis without CAC were below 50 years old in the present study and advanced age was one of the independent predictors of the presence of NCPs.…”

Section: Discussioncontrasting

confidence: 61%

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Predictive Factors of the Presence and Number of Noncalcified Coronary Plaque in Japanese Patients with Zero Coronary Artery Calcium Score Using 64-Slice Multi-Detector Computed Tomography

Noda¹,

Matsutera²,

Yasuoka³

et al. 2013

ACT

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Background: Factors that can predict the presence and number of noncalcified coronary plaques (NCP) in Japanese patients with zero coronary artery calcium scores (CACS) essentially remain undefined. Methods and Results: We assessed independent predictors of the presence and number of segments with NCP in 111 Japanese patients with zero CACS who underwent 64-slice multi-detector computed tomography at our hospital. Thirty five patients (32%) had NCP, and 24 patients (22%) had ≥ 2 NCPs. Multiple logistic regression analysis revealed that significant predictors for the presence of NCP were age (odds ratio [OR]: 1.06, 95% confidence interval [CI] 1.01 -1.11, p = 0.021), male (OR: 3.61, 95% CI 1.40 -9.35, p = 0.008) and diabetes mellitus (OR: 3.10, 95% CI 1.02 -9.45, p = 0.046), and those for the presence of ≥ 2 NCPs were age (OR: 1.08, 95% CI 1.02 -1.15, p = 0.007) and a current smoking habit (OR: 5.09, 95% CI 1.00 -25.74, p = 0.049). Multiple linear regression analysis identified advanced age, male gender and diabetes mellitus as independent predictors of the number of NCPs. A novel score calculated from the above four predictors showed moderate accuracy for a diagnosis of NCP and ≥ 2 NCPs, with areas under receiver operating curves of 0.738 and 0.736, respectively. Conclusions: Male Japanese patients with zero CACS, advanced age, diabetes mellitus and a current smoking habit might have NCPs.

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Section: Discussioncontrasting

confidence: 61%

“…Several studies have indicated a higher prevalence of significant CAD without CAC for patients below 50 years of age [16,[26][27][28]. Moreover, zero CACS might reliably exclude obstructive CAD among older patients [16,26,29].…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of the Presence and Number of Noncalcified Coronary Plaque in Japanese Patients with Zero Coronary Artery Calcium Score Using 64-Slice Multi-Detector Computed Tomography

Noda¹,

Matsutera²,

Yasuoka³

et al. 2013

ACT

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“…This NPV value is considerably worse than the NPV published by other authors like Meyer at al. (NPV = 100 %) and Akram et al (NPV = 92 %) [30,31]. In consequence, the low-end percentile ranks are affected by this coincidence, too.…”

mentioning

confidence: 87%

“…Perzentile für Kaukasier nach MESA [30]. 1 Percentile for patients with no regular intake of cardiovascular medication according to Schmermund et al [29].…”

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confidence: 99%

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Predictive Value of Zero Calcium Score and Low-End Percentiles for the Presence of Significant Coronary Artery Stenosis in Stable Patients with Suspected Coronary Artery Disease

Vogler

Meyer

Fink

et al. 2013

Fortschr Röntgenstr

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Purpose: To prospectively investigate the predictive value of a zero calcium score (CS) value as well as age- and sex-adjusted low-end CS percentiles for the presence of significant coronary artery stenosis in stable patients with suspected coronary artery disease (CAD). Materials and Methods: In total, 87 consecutive stable patients with suspected CAD?were prospectively enrolled in this study (33 women; 66???10 years). All patients underwent non-enhanced CT for calcium scoring (CSCT) and contrast-enhanced coronary CT angiography (cCTA). Invasive coronary angiography (ICA) served as the reference standard in all patients. Diagnostic performance for the presence of significant stenosis (??50?% diameter) was calculated separately for CS in comparison to cCTA and ICA. Results: ICA identified significant stenosis in 56/87 patients (64?%). The mean CS was 571???599. On a per patient based analysis, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for patients with a zero CS were 98.5?%, 18.2?%, 78.0?% and 80.0?%, respectively, compared to cCTA and 100?%, 16.1?%, 68.3?% and 100?%, respectively, compared to ICA. Low-end age- and sex-adjusted percentiles derived from asymptomatic Caucasian populations showed results comparable to a CS of zero. Conclusion: The prevalence of significant coronary artery stenosis is low in stable patients with suspected CAD?and a CS of zero but also in patients below certain low-end age- and sex-adjusted percentile ranks. Thus, CS should be used as a gatekeeper prior to further diagnostic procedures in these patients. A CS value below certain age- and sex-adjusted percentile ranks seems to be of identical diagnostic value to a CS of zero in stable patients.

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Noncalcified plaque: Relationship between results of multislice computed tomography, risk factors, and late clinical outcome

Aggarwal

Knickelbine

Tande

et al. 2011

Cathet Cardio Intervent

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Influence of symptomatic status on the prevalence of obstructive coronary artery disease in patients with zero calcium score

Cited by 79 publications

References 26 publications

Predictive Factors of the Presence and Number of Noncalcified Coronary Plaque in Japanese Patients with Zero Coronary Artery Calcium Score Using 64-Slice Multi-Detector Computed Tomography

Predictive Factors of the Presence and Number of Noncalcified Coronary Plaque in Japanese Patients with Zero Coronary Artery Calcium Score Using 64-Slice Multi-Detector Computed Tomography

Predictive Value of Zero Calcium Score and Low-End Percentiles for the Presence of Significant Coronary Artery Stenosis in Stable Patients with Suspected Coronary Artery Disease

Noncalcified plaque: Relationship between results of multislice computed tomography, risk factors, and late clinical outcome

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