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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
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The Prognostic Value of CAC Zero Among Individuals Presenting With Chest Pain: A Meta-Analysis
Ali M Agha1, Justin Pacor2, Gowtham R Grandhi3
1Baylor College of Medicine, Houston, Texas, USA.
JACC. Cardiovascular Imaging
|October 6, 2022
Summary
Absence of coronary artery calcium (CAC) in patients with chest pain effectively rules out obstructive coronary artery disease (CAD). A CAC score of zero indicates a very low risk of major adverse cardiac events, supporting its use in guiding further testing.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Limited consensus exists on using coronary artery calcium (CAC) absence to safely defer further testing in patients with chest pain (CP).
- Evaluating the utility of CAC assessment is crucial for managing patients with suspected coronary artery disease (CAD).
Purpose of the Study:
- To systematically review and meta-analyze the effectiveness of CAC assessment in ruling out obstructive CAD.
- To investigate CAC's role in patients with stable and acute CP at low-to-intermediate risk undergoing coronary computed tomography angiography (CTA).
Main Methods:
- Systematic review and meta-analysis of studies published between 2005 and 2021.
- Included studies examined the relationship between CAC and obstructive CAD (≥50% narrowing) on coronary CTA.
- Analyzed data from 19 papers (79,903 patients) with stable CP and 13 papers (12,376 patients) with acute CP.
Main Results:
- A CAC score of 0 was found in 45% of stable CP and 58% of acute CP patients.
- The negative predictive value of CAC=0 for obstructive CAD was high (97% for stable, 98% for acute CP).
- CAC=0 was associated with low prevalence of nonobstructive CAD and low rates of major adverse cardiac events (0.5%-0.8%).
Conclusions:
- Absence of CAC in over 92,000 patients strongly correlates with a very low prevalence of obstructive and nonobstructive CAD.
- A zero CAC score is linked to a low annualized risk of major adverse cardiac events.
- CAC=0 can serve as a "gatekeeper" to potentially avoid unnecessary advanced imaging in CP patients within value-based care models.
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