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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Diagnostic and prognostic value of absence of coronary artery calcification
Ammar Sarwar1, Leslee J Shaw, Michael D Shapiro
1Cardiac PET CT MRI Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Insights
Absence of coronary artery calcification (CAC) indicates a very low risk of future cardiovascular events. Even in symptomatic individuals, no CAC suggests minimal risk, offering significant prognostic value.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Preventive Medicine
Background:
- Coronary artery calcification (CAC) is a marker of coronary plaque burden and elevated cardiovascular risk.
- Absence of CAC is linked to a low risk of significant coronary artery disease and future adverse events.
Purpose of the Study:
- To systematically evaluate the diagnostic and prognostic value of the absence of coronary artery calcification (CAC).
- To assess the utility of CAC absence in both asymptomatic and symptomatic individuals for cardiovascular risk stratification.
Main Methods:
- Conducted a systematic review of original research articles published between January 1990 and March 2008.
- Searched major online databases including PubMed and MEDLINE for relevant studies.
- Included studies examining the diagnostic and prognostic utility of CAC in diverse patient populations.
Main Results:
- Analysis of 49 studies involving over 85,000 patients.
- In asymptomatic individuals (64,873 patients), absence of CAC was associated with a 0.56% cardiovascular event rate over 51 months.
- In symptomatic individuals, the event rate without CAC was 1.80%.
- Absence of CAC demonstrated a 99% negative predictive value for ruling out acute coronary syndrome and showed minimal association with ischemia.
Conclusions:
- The absence of CAC is strongly associated with a very low risk of future cardiovascular events.
- Diagnostic tests have modest incremental value in individuals with no detectable CAC.
- Findings support the use of CAC absence for cardiovascular risk assessment and potentially guiding further diagnostic workup.
Objectives:
In this study, we systematically assessed the diagnostic and prognostic value of absence of coronary artery calcification (CAC) in asymptomatic and symptomatic individuals.
Background:
Presence of CAC is a well-established marker of coronary plaque burden and is associated with a higher risk of adverse cardiovascular outcomes. Absence of CAC has been suggested to be associated with a very low risk of significant coronary artery disease, as well as minimal risk of future events.
Methods:
We searched online databases (e.g., PubMed and MEDLINE) for original research articles published in English between January 1990 and March 2008 examining the diagnostic and prognostic utility of CAC.
Results:
A systematic review of published articles revealed 49 studies that fulfilled our criteria for inclusion. These included 13 studies assessing the relationship of CAC with adverse cardiovascular outcomes in 64,873 asymptomatic patients. In this cohort, 146 of 25,903 patients without CAC (0.56%) had a cardiovascular event during a mean follow-up period of 51 months. In the 7 studies assessing the prognostic value of CAC in a symptomatic population, 1.80% of patients without CAC had a cardiovascular event. Overall, 18 studies demonstrated that the presence of any CAC had a pooled sensitivity and negative predictive value of 98% and 93%, respectively, for detection of significant coronary artery disease on invasive coronary angiography. In 4,870 individuals undergoing myocardial perfusion and CAC testing, in the absence of CAC, only 6% demonstrated any sign of ischemia. Finally, 3 studies demonstrated that absence of CAC had a negative predictive value of 99% for ruling out acute coronary syndrome.
Conclusions:
On the basis of our review of more than 85,000 patients, we conclude that the absence of CAC is associated with a very low risk of future cardiovascular events, with modest incremental value of other diagnostic tests in this very low-risk group.
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